Literature Review
All posts tagged with “Clinical News | Ethics.”
Muslim community-engaged research highlights Muslim Americans' end-of-life-healthcare gaps and needs
12/26/24 at 03:00 AMMuslim community-engaged research highlights Muslim Americans' end-of-life-healthcare gaps and needs WisconsinMuslimJournal.org; by Sandra Whitehead; 12/20/24 Few Muslim Americans use hospice care, despite its posited benefits. A multi-sectoral team of academicians and community leaders in southeastern Wisconsin decided to find out why. ... Muslims are one of the fastest-growing religious communities in the United States, numbering between 3 to 5 million, with projections it will double by 2050. “With an aging Muslim population, there is a growing need for specialized healthcare services like hospice and palliative care,” the team’s research explains. ... Through a qualitative descriptive study with a Muslim patient and 10 family caregivers, the research team identified their perceptions of hospice care, ethical concerns and experiences. Among their varied perceptions, many saw it as useful only in the last hours of life. Participants also had ethical concerns about the use of sedative medication and with cessation of feeding terminally ill patients. Some had concerns about how hospice care might lead to unnecessary interventions or even hasten death. ... The team is developing an informational resource, Islamic Bioethical Considerations for the End of Life: A Guide for Muslim Americans, to help Muslims who struggle when thinking about death and dying.
31 Photos and stories that show how expensive it is to die in America
12/23/24 at 03:00 AM31 Photos and stories that show how expensive it is to die in America
Rabbi emphasizes balancing tradition, innovation in culturally competent care
12/23/24 at 03:00 AMRabbi emphasizes balancing tradition, innovation in culturally competent care Yeshiva University; by Dave DeFusco; 12/20/24 Rabbi Dr. Edward Reichman, professor in the Department of Emergency Medicine at Albert Einstein College of Medicine, underscored the importance of understanding various religious practices to provide culturally competent care in his presentation, “Are Pig Heart Transplants Kosher? Judaism and Modern Medicine in the 21st Century,” as part of an interprofessional practice seminar ... Rabbi Reichman offered practical advice for healthcare professionals treating Jewish patients. Key considerations included: ...
How innovative designs can help ease ethical tension in good dementia caregiving and decision-making
12/14/24 at 03:05 AMHow innovative designs can help ease ethical tension in good dementia caregiving and decision-makingAMA Journal of Ethics; Emily Roberts, PhD; 12/24The European dementia village is a pioneering health care site: 4 acres of integrated housing and amenities that include large exterior walkways around gardens, restaurants, and shops. A US-based conceptual model is the dementia friendly city center [DFCC], which integrates health care service delivery into adaptive reuse and urban revitalization. Separately and together, we can work to deliver new interventions that can make a difference for those living with dementia and their families. Further exploration of the DFCC model is required to address possible financial and regulatory constraints that accompany the development of necessary public health infrastructure.
HSPN Staffing Summit: Leveraging technology for person-centered care
12/11/24 at 03:00 AMHSPN Staffing Summit: Leveraging technology for person-centered care Hospice News; by Sophie Knoelke; 12/9/24 This article is sponsored by CareXM. This article is based on a virtual discussion with Kathleen Benton, President and CEO of Hospice Savannah. ... Dr. Benton has a master’s degree in medical ethics and a doctorate in public health. She has offered and reviewed many publications relevant to the topics of palliative care, ethics, hospice, and communication. [Dr. Benton:] I was schooled in clinical ethics and really mediating ethical dilemmas in health care. Looking at, is this in the best interest of the patient? Are we truly following the patient’s wishes? Many of the dilemmas, I would say a good 90%, occur at the end of life. ... [At] the root of [really trending] cases was one missing element. That element was the lacking area of communication. What do I mean by that? I believe that health care does the worst job of probably all other areas of communicating with folks. We have really taken what it is to be human out of what it is to treat a patient and a person. [Click on the title's link to continue reading this insightful discussion.]
Palliative care bypasses Black heart disease patients
12/02/24 at 02:00 AMPalliative care bypasses Black heart disease patients The St. Louis American; by Alvin A. Reid; 11/30/24 A study by Saint Louis University researchers paints a grim picture for many heart failure patients in America – and the outlook is worse for African Americans. The study, published in the Journal of the American Heart Association, found that only one in eight patients with heart failure nationwide receive palliative care consultations within five years of diagnosis. Alarmingly, Black people were 15% less likely to receive palliative care compared to white patients with similar heart health illness. Other recent respective studies illustrate the higher risk and mortality rates for cardiovascular disease in the Black population – further demonstrating that the missing palliative care options have a greater negative impact on African American health. New statistics from a medical team at EHproject show African American women are at a greater risk for cardiovascular disease than their white counterparts. It found that 47.3% of Black women have heart disease. If they do not have it currently, they are 2.4 times more likely to develop heart disease. ... A March 2023 study published in JAMA Cardiology showed that Black men remain at the highest risk of dying from cardiovascular disease. ...
AI can’t worry about patients, and a clinical ethicist says that matters
11/30/24 at 03:40 AMAI can’t worry about patients, and a clinical ethicist says that mattersJAMA; Yulin Hswen, ScD, MPH; Jennifer Abbasi; 11/24This conversation is part of a series of interviews in which JAMA Network editors and expert guests explore issues surrounding the rapidly evolving intersection of artificial intelligence (AI) and medicine. Today, Hull is an associate professor and serves as associate director of the biomedical ethics program at Yale, where her clinical practice focuses on echocardiography and cardiac care of patients with cancer. She spoke about ethical boundaries for using AI in the clinic in a recent conversation with Yulin Hswen, ScD, MPH, an associate editor at JAMA and the newly launched JAMA+ AI and an assistant professor of epidemiology and biostatistics at the University of California, San Francisco. Medicine is, they remind the reader, “as much art as science, as much a moral endeavor as a technical one.”
World Medical Association Declaration of Helsinki-Ethical principles for medical research involving human participants
11/23/24 at 03:50 AMWorld Medical Association Declaration of Helsinki-Ethical principles for medical research involving human participantsJAMA; World Medical Association; 10/24Preamble: The World Medical Association (WMA) has developed the Declaration of Helsinki as a statement of ethical principles for medical research involving human participants, including research using identifiable human material or data. The Declaration is intended to be read as a whole, and each of its constituent paragraphs should be applied with consideration of all other relevant paragraphs. While the Declaration is adopted by physicians, the WMA holds that these principles should be upheld by all individuals, teams, and organizations involved in medical research, as these principles are fundamental to respect for and protection of all research participants, including both patients and healthy volunteers.
Promotion of knowledge and trust surrounding scarce resource allocation policies-A randomized clinical trial
11/09/24 at 03:35 AMPromotion of knowledge and trust surrounding scarce resource allocation policies-A randomized clinical trialJAMA Health Forum; Russell G. Buhr, MD, PhD1; Ruby Romero, BA; Lauren E. Wisk, PhD; 10/24The COVID-19 pandemic prompted rapid development of scarce resource allocation policies (SRAPs) in case demand for critical health services eclipsed capacity. [This] trial found that a brief educational video is sufficient to explain complex ethical tenets and mechanics of SRAP and improved knowledge of such policies and trust in health systems to implement them equitably while not exacerbating anxiety about potential policy implications. This informs practice by providing a framework for educating people about the use of these policies during future situations necessitating crisis standards of care.
Guidelines vary when surrogates with power of attorney disagree with advance directives
10/31/24 at 03:00 AMGuidelines vary when surrogates with power of attorney disagree with advance directives Healio, Boston, MA; by Richard Gawel; 10/30/24 Inconsistent guidelines can lead to conflicts when surrogates with powers of attorney disagree with what may be described in a patient’s advance directive, according to a poster presented at the CHEST Annual Meeting. ... Key takeaways:
Ethics roundtable state-erected barriers to end-of-life care
10/26/24 at 03:40 AMEthics roundtable state-erected barriers to end-of-life careAmerican Journal of Hospice and Palliative Medicine; by Saima Rashid, Scott P Broyles, Andrew Wampler, Matthew Stolick, Steven J Baumrucker; 10/24[An interesting ethics case study discussed from physician, spiritual care, legal, and ethics perspectives. Discussion focused on conflicts between healthcare ethics and state law.]
[Scotland] Palliative care-based arguments against assisted dying
10/12/24 at 03:55 AM[Scotland] Palliative care-based arguments against assisted dyingBioethics; Ben Colburn; 10/24Opponents of legalised assisted dying often assert that palliative care is worse in countries where assisted dying has been legalised, and imply that legalised assisted dying makes palliative care worse. This study considers five versions of this claim: that it is difficulty to access expert palliative care in countries where assisted dying has been legalised, that those countries rank low in their quality of end-of-life care; that legalising assisted dying doesn't expand patient choice in respect of palliative care; that growth in palliative care services has stalled in countries where assisted dying has been legalised; and that legalised assisted dying impedes the growth of palliative care or causes it to decline. In each case, it concludes that neither argumentation nor evidence supports these claims.
Research involving the recently deceased: ethics questions that must be answered
09/21/24 at 03:15 AMResearch involving the recently deceased: ethics questions that must be answeredJournal of Medical Ethics; by Brendan Parent, Olivia S Kates, Wadih Arap, Arthur Caplan, Brian Childs, Neal W Dickert, Mary Homan, Kathy Kinlaw, Ayannah Lang, Stephen Latham, Macey L Levan, Robert D Truog, Adam Webb, Paul Root Wolpe, Rebecca D Pentz; 8/24Research involving recently deceased humans that are physiologically maintained following declaration of death by neurologic criteria-or 'research involving the recently deceased'-can fill a translational research gap while reducing harm to animals and living human subjects. It also creates new challenges for honouring the donor's legacy, respecting the rights of donor loved ones, resource allocation and public health. As this research model gains traction, new empirical ethics questions must be answered to preserve public trust in all forms of tissue donation and in the practice of medicine while respecting the legacy of the deceased and the rights of donor loved ones. This article suggests several topics for immediate investigation to understand the attitudes and experiences of researchers, clinical collaborators, donor loved ones and the public to ensure research involving the recently deceased advances ethically.
Allowing patients to die: Louise Aronson and Bill Andereck
09/06/24 at 03:00 AMAllowing patients to die: Louise Aronson and Bill AndereckGeriPal podcast; by Alex Smith, Eric Widera, Louise Aronson, Bill Andereck; 9/5/24In today’s podcast we set the stage with the story of Dax Cowart, who in 1973 was a 25 year old man horribly burned in a freak accident. Two thirds of his body was burned, most of his fingers were amputated, and he lost vision in both eyes. During his 14 month recovery Dax repeatedly demanded that he be allowed to die. The requests were ignored. After, he said he was both glad to be alive, and that the doctors should have respected his wish to be allowed to die. But that was 1973, you might say. We don’t have such issues today, do we? Louise Aronson’s recent perspective about her mother in the NEJM, titled, “Beyond Code Status” suggests no, we still struggle with this issue. And Bill Andereck is still haunted by the decision he made to have the police break down the door to rescue his patient who attempted suicide in the 1980s, as detailed in this essay in the Cambridge Quarterly of HealthCare Ethics.
What is Death?
08/26/24 at 03:00 AMWhat is Death?GeriPal podcast; by Eric Widera, Alex Smith, Winston Chiong, Sean Aas; 8/22/24We’ve talked about Brain Death before ... and in many ways today’s podcast is a follow up to that episode. Why does this issue keep coming up? Why is it unresolved? Today we put these questions to Winston Chiong, a neurologist and bioethicist, and Sean Aas, a philosopher and bioethicist.
The Hastings Center awarded $1.5 million by PCORI to study organizational trustworthiness and community-engaged research
08/19/24 at 03:00 AMThe Hastings Center awarded $1.5 million by PCORI to study organizational trustworthiness and community-engaged research EurekAlert! AAAS; Susan Gilbert, The Hastings Center; 8/13/24 A research team at The Hastings Center has been approved for $1.5 million in funding by the Patient-Centered Outcomes Research Institute (PCORI) to study organizational trustworthiness as it relates to community-engaged research. Led by Virginia A. Brown, PhD, a research scholar at The Hastings Center, the study will be the first to investigate the role of organizational trustworthiness in shaping research engagement processes and outcomes.
Person-centered, goal-oriented care helped my patients improve their quality of life
08/16/24 at 02:15 AMPerson-centered, goal-oriented care helped my patients improve their quality of life Journal of the American Board of Family Medicine; by Lee A. Jennings and James W. Mold; orignially posted 5/24 issue, again on 8/15/24 When the goal is to help patients improve their quality of life, it makes sense to focus directly on the activities and relationships that are most important to each patient. This can be accomplished most effectively by following a three-step process that includes 1) connecting with the patient around what matters to them, 2) co-creating a goal-oriented plan, and 3) collaborating with patient, family, team members, and consultants to increase the probability of success. Once this approach has been mastered and the necessary systems, processes, and relationships are in place, this should not take more time than a problem-oriented approach, and it will almost certainly be more satisfying for both physician and patient. Editor's Note: Simple. Effective. Meaningful.
Everyday ethics or deference to expertise: experiences of pediatric palliative care teams with ethics consultancy
07/20/24 at 03:25 AMEveryday ethics or deference to expertise: experiences of pediatric palliative care teams with ethics consultancyJournal of Palliative Medicine; Anessa M Foxwell, Connie M Ulrich, Jennifer K Walter, Meaghann S Weaver; 7/24Little is known about the extent to which pediatric palliative care (PPC) clinicians are engaged in ethics consults or how they perceive interactions with ethics consultants. Online survey distributed to members of the American Academy of Pediatrics and American Academy of Hospice and Palliative Care pediatric and ethics section and special interest groups in the United States. Eighty-six responses were obtained (response rate 45%) from PPC teams in 70 different children's hospitals located in 34 states. Almost all (97%) reported a functional ethics consult service such that PPC is not expected to meet the ethics need of the institution. A person involved on the PPC team also performed ethics consults in half (49%) of the settings, predominantly the PPC physician. Most respondents who perceive PPC teams engage in ethics-relevant work as part of their everyday PPC work. Formal ethics training was lacking among PPC members involved in ethics consults with few ethics degrees (15%), certifications (6%), or fellowships (2%). Discord (67%), conflict (49%), limitations to treatment (48%), and distress (41%) were cited as the most frequent reasons for which PPC teams consult ethics. PPC respondents identified role clarity, coordinated engagement, timely presence, and open communication as strong PHCE consultant practices. Conclusions: PPC team members performing ethics consults may benefit from additional ethics education and training.
Ethics at the end of life
07/06/24 at 03:30 AMEthics at the end of lifeMedicine; by John Idris Baker; 7/24End-of-life care has always been prominent in discussions of clinical ethics. Almost 30% of hospital inpatients are in their last year of life. Doctors frequently encounter people with end-of-life care needs and should to be equipped to respond... Key points:
Reply to: Frailty and ethics at the end of life: The importance of a comprehensive assessment
06/10/24 at 03:00 AMReply to: Frailty and ethics at the end of life: The importance of a comprehensive assessmentJournal of the American Geriatrics Society; by Colum Thomas MD, Eduardo Bruera MD, William Breitbart MD, Yesne Alici MD, Liz Blackler MBE, LCSW-R, Julia D. Kulikowski MD, Daniel P. Sulmasy MD, PhD; 6/5/24The care of older persons at the end of life often involves competing concerns and highly value-sensitive decisions. In a recent article, we proposed a set of ethical rules—the canons of therapy—to help clinicians navigate complex cases involving older adults with delirium at the end of life. The canons of therapy most pertinent to such cases are restoration, means-end proportionality, discretion, and parsimony (see Table 1 for a description). These canons provide a structured toolset aligned with practical wisdom, which can serve as an ethical heuristic for guiding therapeutic judgments. ...
The real cost of cancer: 49% of patients carry $5K+ in medical debt
05/30/24 at 02:00 AMThe real cost of cancer: 49% of patients carry $5K+ in medical debt Becker's Hospital Review; by Ashleigh Hollowell; 5/28/24 ... Now, 47% of cancer patients accumulate debt as a result of their medical needs, The Wall Street Journal reported May 28. ... Some Americans are facing $38,000 or even more in medical debt, the Journal found. Additionally, more cancer patients are filing for bankruptcy, which one study linked to an 80% increased risk of dying. ... A 2024 survey of 1,284 cancer patients and survivors led by the American Cancer Society Cancer Action Network also found that: ...
Comment: Rule must change to allow dialysis as end-of-life care
04/16/24 at 03:00 AMComment: Rule must change to allow dialysis as end-of-life care HeraldNet, by Matthew Rivara and Mackenzie Daniek; 4/13/24More than 1 in 7 American adults live with chronic kidney disease, making it one of the most common chronic disease conditions in the United States. ... Medicare will generally not reimburse health care providers for dialysis treatments if a patient has elected to enter hospice care, as dialysis treatments are considered by Medicare to be “curative” rather than “palliative” care. Because of this, most patients getting dialysis for ESRD must forego all dialysis treatment after entering a hospice program.
From doctor to family: Witnessing both sides of end-of-life care
03/29/24 at 03:00 AMFrom doctor to family: Witnessing both sides of end-of-life care MedPage Today's KevinMD.com, by Jessica Bloom, MD; 3/27/24We all have those moments in medicine when we know that care has become more futile. Then we do everything in our power to educate, support, gently guide, and give permission to patients and families. There are moments that treating for a cure goes against our tenet to “first do no harm.” ... Specialists and his regular physicians sat with us, listened to my family’s questions, and offered kindness along with medical advice. They gently helped my siblings let go of futile searching for treatments. ...
Antibiotics in end-of-life care
03/29/24 at 03:00 AMAntibiotics in end-of-life care NEJM Journal Watch, by Abigail Zuger, MD; 3/27/24Antibiotics often are considered to be among the gentler and more comfort-oriented interventions in end-of-life care, certainly far less aggressive than intubation or last-ditch surgery. ... Still, antibiotics do entail their own costs in the form of toxicities and need for intravenous access, and liberal antibiotic use reliably worsens institutional and community drug-resistance profiles. ... A new review was written for infectious disease consultants but contains specific suggestions that should interest both generalists and other subspecialists caring for dying patients.
Dr. Kevorkian was convicted of murder 25 years ago today: Examining the mixed legacy of a fighter for patient autonomy
03/27/24 at 03:00 AMDr. Kevorkian was convicted of murder 25 years ago today: Examining the mixed legacy of a fighter for patient autonomy Reason, by Jeffrey A. Singer; 3/26/24Today marks the 25th anniversary of Dr. Jack Kevorkian's conviction of second-degree murder for performing euthanasia on Thomas Youk, a Michigan man suffering from amyotrophic lateral sclerosis, or Lou Gehrig's Disease. ... Kevorkian, a medical pathologist, had been defying state laws by engaging in assisted suicide—he claimed to help more than 130 people die— often using machines. But this was different. Kevorkian was not assisting a suicide. Kevorkian videotaped himself injecting Youk with lethal chemicals. He was doing all the work. And despite having received Youk's informed consent, the Michigan Court considered it murder. ... Today, physician-assisted suicide is legal in 11 jurisdictions: California, Colorado, the District of Columbia, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington. ... Autonomous adults have the right to govern their bodies freely, provided they respect the equal rights of others. ... Active and passive euthanasia are grim exercises for physicians like me who decided to become doctors because we wanted to save lives. ... Editor's Note: Read more from this article that provides significant contexts for today's conflicts: historical, legal, medical, ethical, and geographical (USA and international) .