Clinical & Medical Ethics

Revisiting an Ethical Conundrum: An Older Person’s Friend or a Renewed Assault on the Biologically Tenacious?

Should older persons suffering the ravages of advanced dementia be treated with antibiotics for intervening infections? The manner in which this argument is framed is in many ways predictive of how one defines personhood.

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Is It Permissible to Shut Off this Pacemaker?

The ethics consultant met with the patient and two of her daughters. Dorthea says she wants to die now because (a) she misses her husband who died three years ago after 45 years of marriage; they were very close, did everything together, and she says she can’t live without him; (b) she can’t stand to live in their home (memories), but refuses to move; and (c) she wants to “set her children free.” She has resisted attempts by her three daughters who have encouraged treatment, including grief counseling, and have even offered for her to live with them. She has guns in her home and knows how to use them, but she says she is unwilling to take her own life. She is an inactive Methodist. She says her only pleasure is having her children, grandchildren and great-grandchildren visit, but she feels her misery is also making them miserable.

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Permissibility to Stop Off-Label Use of Expensive Drug Treatment for Child

Is it ethically permissible to stop the off-label use[1] of an expensive drug in this child with Gaucher’s disease since it is likely not working and she may be suffering because of its continued use?

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Permissibility to Stop Man's Ventilator on His Request

Is it ethically permissible to stop this man’s ventilator at his request?

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Christian-Hippocratism, Confidentiality, and Managed Care: A Volatile Mix

With these words the Hippocratic Oath places confidentiality squarely in the context of the medical ethos. Confidentiality in the physician-patient relationship is a good, but not an absolute good or the so-called summum bonum. The words of the Oath also imply that certain shared admissions--like threatened mortal danger to another--may supercede the relative good of confidentiality. Protection of life is something that allows sharing of what otherwise ought not to be spoken abroad.

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Permissibility to Accept Refusal of Potentially Life-Saving Treatment

This column presents a case that poses an ethical dilemma for patients, families and healthcare professionals. It is based on a real case, though some facts have been changed to preserve confidentiality. The story is presented to a Fellow of the Center for Bioethics and Human Dignity, and his or her analysis is published for our readers. Our goal is to offer careful ethical analyses and recommendations that are consistent with biblical standards.

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Please UNOS--Transplantation is a Fragile Public Trust

It has been said that, “. . . it takes years to build up trust, and it only takes suspicion, not proof, to destroy it.”[1] The words themselves tell us something about human nature, and unfortunately, are prescient in the context of organ transplants. At a time when a severe shortfall in donation has become emotionally palpable—approximately 18 people die every day while waiting—transplantation survives, imbedded within a fabric of trust. Those who donate their or their loved one’s organs expect that certain precepts will be honored. For example, there is the dead donor rule. If someone has agreed to donate organs after they die, either by whole brain or heart criteria, they must be dead and not merely dying when organs are retrieved. As a result, fiction like Robin Cook’s Comacan send a shudder throughout the transplant community. Similarly, in the mid 1990s, when newspapers intimated that cardiac criteria for death may have led to premature organ retrieval, concern was immediate and intense. Americans also respect a “level playing field.” Remember the public outcry surrounding Mickey Mantle’s liver transplant? Allowing the famous or rich to jump ahead of the vulnerable is not the American way. Finally, in an era of quality and safety concerns, the lifesaving process of transplantation should be transparent, compassionate, just, and as safe and quality laden as possible. There are diverse “patients” involved: donors, recipients, and both families. The public should continue to be very sensitive to potential abuses. This necessary vigilance represents transplantation’s critical check and balance.

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End of Life Decisions 101

The care of patients near the end of life can be ethically challenging. Physicians and other health care professionals may find certain concepts vague and hard to understand. Furthermore, there must be a balance between two extremes: a treat-at-all-costs vitalism on the one hand, and a too-rapid withdrawal of potentially beneficial treatments on the other. The purpose of this article is to provide some conceptual clarity.

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