Clinical & Medical Ethics

To Dialyze or Not to Dialyze

Is it mandatory to dialyze a combative patient who is a threat to himself and to others?
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Continuing "Futile" ICU Support at Relative's Insistence

Must we continue "futile" ICU support for this dying man at the insistence of his son?

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Discerning Palliative Sedation from Euthanasia: What’s at Stake for Human Dignity

The last presidential election saw Washington become the second state to legalize physician-assisted suicide (PAS).  Pressure will increase for other states to follow suit so that those who are terminally ill can exercise the full scope of their “autonomy” and “die with dignity” through PAS if they so choose. Many concerned persons see trends toward legalizing PAS and the broad acceptance of euthanasia as not upholding the inherent dignity of human persons as is often claimed, but actually undermining it. 

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The Global Outcomes Movement: Is it Compatible with Medicine?

We will look at these two characteristics, the claim to objectivity and the scientistic turn, by examining competency-based medical education in some detail. The effects of this now-mandated system on the medical profession will be discussed.

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Shared Decision Making: A Spectrum of Directiveness

This presentation discusses paternalism and 6 styles of shared decision making, examining whether each style is ethically defensible. The spectrum spans from least directive to most: abdication, informational, guidance, persuasion, manipulation, and coercion. Clinical examples of each will be given. A suggested model to improve when to utilize each style will also be offered.

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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.

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Professionalism in Peril

Plenary Address from CBHD's 15th Annual Conference: Healthcare and the Common Good.

On the Permissibility of a DNR Order for Patient with Dismal Prognosis

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Is it ethically permissible to write a DNR order and withdraw the ventilator from this patient with a dismal prognosis?

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