Clinical & Medical Ethics

Clinical Ethics Dilemmas: Capitulation to a Patient’s Demands

Editor’s Note: This column presents a problematic case that poses a medical-ethical dilemma for patients, families, and healthcare professionals. As it is based on a real case, some details have been changed in the effort to maintain patient confidentiality. The intent of this presentation is to offer ethical analysis and medical recommendations that are consistent with biblical principles. In this case, we explore the weakness of professional healthcare when the patient is demanding, the medical team has weak communication, and there is subsequent capitulation.

Podcast Episode: 
172

Clinical Ethics Dilemmas: How Does the Doctor Decide Between Cost and Care?

Column Editor’s note:  This column presents a problematic case that poses a medical-ethical dilemma for patients, families, and healthcare professionals.  As it is based on a real situation, some details have been changed in the effort to maintain confidentiality.  In this case, the community pediatric society struggles with appropriate pediatric care in the face of considerable financial constraints.

Column editor: 
Ferdinand D. (Nick) Yates, Jr., MD, MA, Acting Consultant in Clinical Ethics, CBHD

Podcast Episode: 
169

Commentary: Six Years Later and Katrina Still Engenders Bioethical Debate

During August 2005, the Gulf Coast experienced the most expensive natural disaster in history. The remarkable devastation would be painfully remembered simply as Hurricane Katrina. Amidst the hue and cry of lives lost, levees that failed—and alleged FEMA incompetence—Hurricane Katrina’s darkest moments, especially for medicine, continue to reverberate. It must never be forgotten that after the initial shock from the powerful storm had dissipated, forty-five corpses were retrieved from one New Orleans hospital under suspicious circumstances.[1] A subsequent article reporting the events was trenchant enough to receive a Pulitzer Prize.[2] At the time, it was alleged that some of these forty-five individuals were injected with sedatives such as morphine to relieve either their suffering or to deliberately hasten their deaths.[3] Therein lays the rub of the principle of double effect. The Louisiana Attorney General and prominent forensic scientists labeled what happened homicide.[4] The local coroner later testified in agreement with this claim and provided evidence of the drug levels to demonstrate what should have been a lethal cause and effect. Also critical to the ensuing debate, several of these persons whose death may have been hastened did not have a Do Not Resuscitate order. There was no evidence that any of the individuals consented to assisted suicide. One case study may provide insight.[5]

Podcast Episode: 
165

Adolescent Confidentially: An Uneasy Truce

 

Editor’s Note: This column presents a problematic case that poses a medical-ethical dilemma for patients, families, and healthcare professionals. As it is based on a real case, some details have been omitted in the effort to maintain patient confidentiality. In this case, the doctor discusses her experience from the retrospect of the unanswered question.

Column Editor: Ferdinand D. (Nick) Yates, MD, MA; Professor of Clinical Pediatrics, State University of New York at Buffalo

Podcast Episode: 
163

End-of-Life Care in the Long-Term Cancer Survivor

 

Podcast Episode: 
158

The Need to Know: Disclosure of Information to Pediatric Patients

 

Editor’s note: This column presents a problematic case that poses a medical-ethical dilemma for patients, families, and healthcare professionals. As it is based on a real case, some details have been omitted in the effort to maintain patient confidentiality. This case and discussion point out some of the complexities in treating the minor child. While agreeing with the recommendation, the editor’s comment reflects a different paradigm for approaching the issue of a requested confidentiality purposefully withholding information from the patient.

Podcast Episode: 
152

When I Was Hungry, You Gave Me to Eat: The Dignity of Hand Feeding in Persons with Dementia

Preserving the dignity of those who inhabit Nursing Homes at the end of life—individuals frequently bearing the concurrent burden of dementia— is a critical feature of cultures that embrace compassion. In the United States, such persons comprise a demographic estimated at five million. One demanding aspect of care in this population is feeding. The ethical dilemma resides in the choice between hand feeding by staff or family versus feeding tubes. Hand feeding is adopted when it is comfortable and safe, that is, unaccompanied by aspiration; and although human intimacy integral to hand feeding would be preferable, feeding tubes have become de rigueur in contemporary medical practice. As Kenneth Ludmerer poignantly asked, might the efficiency in time and effort derived from feeding tubes, as well as their reimbursement as medical procedures, be the dynamic driving choice in this context?[1] Recent publications are noteworthy in this regard.

Podcast Episode: 
145

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