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Access to adult liver transplantation in Canada: a survey and ethical analysis.

https://arctichealth.org/en/permalink/ahliterature212821
Source
CMAJ. 1996 Feb 1;154(3):337-42
Publication Type
Article
Date
Feb-1-1996
Author
M A Mullen
N. Kohut
M. Sam
L. Blendis
P A Singer
Author Affiliation
University of Toronto Joint Centre for Bioethics, Ont.
Source
CMAJ. 1996 Feb 1;154(3):337-42
Date
Feb-1-1996
Language
English
Publication Type
Article
Keywords
Adult
Canada
Data Collection
Health Care Rationing - organization & administration
Health Services Accessibility - organization & administration
Humans
Liver Transplantation
Organizational Policy
Patient Selection
Resource Allocation
Waiting Lists
Abstract
To describe the substantive and procedural criteria used for placing patients on the waiting list for liver transplantation and for allocating available livers to patients on the waiting list; to identify principal decision-makers and the main factors limiting liver transplantation in Canada; and to examine how closely cadaveric liver allocation resembles theoretic models of source allocation.
Mailed survey.
Medical directors of all seven Canadian adult liver transplantation centres, or their designates. Six of the questionnaires were completed.
Relative importance of substantive and procedural criteria used to place patients in the waiting list for liver transplantation and to allocate available livers. Identification of principal decision-makers and main limiting factors to adult liver transplantation.
Alcoholism, drug addiction, HIV positivity, primary liver cancer, noncompliance and hepatitis B were the most important criteria that had a negative influence on decisions to place patients on the waiting list for liver transplantation. Severity of disease and urgency were the most important criteria used for selecting patients on the waiting list for transplantation. Criteria that were inconsistent across the centres included social support (for deciding who is placed on the waiting list) and length of time on the waiting list (for deciding who is selected from the list). Although a variety of people were reported as being involved in these decisions, virtually all were reported to be health to be health care professionals. Thirty-seven patients died while waiting for liver transplantation in 1991; the scarcity of cadaveric livers was the main limiting factor.
Criteria for resource allocation decisions regarding liver transplantation are generally consistent among the centres across Canada, although some important inconsistencies remain. Because patients die while on the waiting list and because the primary limiting factor is organ supply, increased organ acquisition efforts are needed.
Notes
Cites: Psychosomatics. 1993 Jul-Aug;34(4):314-238351306
Cites: Arch Intern Med. 1990 Mar;150(3):523-72178581
Cites: BMJ. 1990 Jul 7;301(6742):15-72383700
Cites: N Engl J Med. 1991 Oct 24;325(17):1243-61845039
PubMed ID
8564903 View in PubMed
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Advance directives in family practice.

https://arctichealth.org/en/permalink/ahliterature221091
Source
Can Fam Physician. 1993 May;39:1087-93
Publication Type
Article
Date
May-1993
Author
N. Kohut
P A Singer
Author Affiliation
Centre for Bioethics, University of Toronto.
Source
Can Fam Physician. 1993 May;39:1087-93
Date
May-1993
Language
English
Publication Type
Article
Keywords
Advance Directives - legislation & jurisprudence
Attitude of Health Personnel
Attitude to Health
Canada
Communication
Decision Making
Family Practice - methods
Government Regulation
Humans
Internationality
Judicial Role
Patient Education as Topic - methods
Physician's Role
Abstract
Family physicians can play an important role in helping patients and their families to discuss life-sustaining treatments and to complete advance directives. This article reviews the legal status of, and empirical studies on, advance directives and addresses some important clinical questions about their use relevant to family practice.
Notes
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Cites: Adv Intern Med. 1991;36:57-792024588
Cites: J Am Geriatr Soc. 1993 Feb;41(2):112-68426030
PubMed ID
8499789 View in PubMed
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Bill C-203: a postmortem analysis of the "right-to-die" legislation that died.

https://arctichealth.org/en/permalink/ahliterature221052
Source
CMAJ. 1993 May 15;148(10):1705-8
Publication Type
Article
Date
May-15-1993
Author
L C Charland
P A Singer
Author Affiliation
Centre for Bioethics, University of Toronto, Ont.
Source
CMAJ. 1993 May 15;148(10):1705-8
Date
May-15-1993
Language
English
Publication Type
Article
Keywords
Canada
Euthanasia - legislation & jurisprudence
Humans
Palliative Care
Right to Die - legislation & jurisprudence
Notes
Cites: JAMA. 1988 Oct 14;260(14):2094-53418875
Cites: Am J Med. 1989 Jul;87(1):81-42741985
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Cites: CMAJ. 1992 Mar 15;146(6):829-321544072
Cites: JAMA. 1990 Sep 12;264(10):1295-62388384
PubMed ID
7683569 View in PubMed
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Source
CMAJ. 1996 Jul 15;155(2):177-80
Publication Type
Article
Date
Jul-15-1996
Author
E. Etchells
G. Sharpe
P. Walsh
J R Williams
P A Singer
Author Affiliation
University of Toronto Joint Centre for Bioethics, Department of Medicine.
Source
CMAJ. 1996 Jul 15;155(2):177-80
Date
Jul-15-1996
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada
Emergencies
Ethics, Medical
Health Policy - legislation & jurisprudence
Humans
Informed Consent - legislation & jurisprudence
Male
Mental Competency - legislation & jurisprudence
Patient compliance
Patient satisfaction
Personal Autonomy
Physician's Role
Treatment Outcome
Abstract
Patients are entitled to make decisions about their medical care and to be given relevant information on which to base such decisions. The physicians obligation to obtain the patient's consent to treatment is grounded in the ethical principles of patient autonomy and respect for persons and is affirmed by Canadian law and professional policy. A large body of research supports the view that the process of obtaining consent can improve patient satisfaction and compliance and, ultimately, health outcomes. An exception to the requirement to obtain consent is the emergency treatment of incapable persons, provided there is no reason to believe that the treatment would be contrary to the person's wishes if he or she were capable.
Notes
Cites: J Gen Intern Med. 1990 Nov-Dec;5(6):506-92266433
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Comment In: CMAJ. 1996 Jul 15;155(2):189-908800077
Comment In: CMAJ. 1997 Jan 1;156(1):17-89053277
PubMed ID
8800075 View in PubMed
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Bioethics for clinicians: 4. Voluntariness.

https://arctichealth.org/en/permalink/ahliterature210831
Source
CMAJ. 1996 Oct 15;155(8):1083-6
Publication Type
Article
Date
Oct-15-1996
Author
E. Etchells
G. Sharpe
M J Dykeman
E M Meslin
P A Singer
Author Affiliation
Department of Medicine, University of Toronto, Toronto Hospital, Ont. eetchells@torhosp.toronto.on.ca
Source
CMAJ. 1996 Oct 15;155(8):1083-6
Date
Oct-15-1996
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Attitude to Health
Bioethics
Disclosure
Female
Humans
Informed consent
Institutionalization - legislation & jurisprudence
Male
Malpractice - legislation & jurisprudence
Mentally Ill Persons
Middle Aged
Ontario
Patient Acceptance of Health Care
Patient Advocacy
Personal Autonomy
Professional-Patient Relations
Truth Disclosure
Abstract
In the context of consent, "voluntariness" refers to a patient's right to make health care choices free of any undue influence. However, a patient's freedom to make choices can be compromised by internal factors such as pain and by external factors such as force, coercion and manipulation. In exceptional circumstances--for example, involuntary admission to hospital--patients may be denied their freedom of choice; in such circumstances the least restrictive means possible of managing the patient should always be preferred. Clinicians can minimize the impact of controlling factors on patients' decisions by promoting awareness of available choices, inviting questions and ensuring that decisions are based on an adequate, unbiased disclosure of the relevant information.
Notes
Cites: Clin Geriatr Med. 1994 Aug;10(3):513-257982166
Cites: J Pers Soc Psychol. 1976 Aug;34(2):191-81011073
Cites: Soc Sci Med. 1983;17(3):139-466836348
Cites: Hosp Community Psychiatry. 1985 Aug;36(8):843-74029908
Cites: Soc Sci Med. 1991;32(6):725-312035049
Cites: Bull Am Acad Psychiatry Law. 1993;21(3):321-97908543
PubMed ID
8873637 View in PubMed
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Bioethics for clinicians: 5. Substitute decision-making.

https://arctichealth.org/en/permalink/ahliterature210569
Source
CMAJ. 1996 Nov 15;155(10):1435-7
Publication Type
Article
Date
Nov-15-1996
Author
N M Lazar
G G Greiner
G. Robertson
P A Singer
Author Affiliation
University of Toronto. nlazar@torhosp.toronto.on.ca
Source
CMAJ. 1996 Nov 15;155(10):1435-7
Date
Nov-15-1996
Language
English
Publication Type
Article
Keywords
AIDS Dementia Complex - therapy
Aged
Aged, 80 and over
Alzheimer Disease - therapy
Bioethics
Canada
Fatal Outcome
Female
Humans
Life Support Care - legislation & jurisprudence
Lung Diseases, Obstructive - therapy
Male
Patient Acceptance of Health Care
Patient Advocacy - legislation & jurisprudence
Personal Autonomy
Abstract
Substitute decision-making is a means of making health care decisions on behalf of people who are incapable of making these decisions for themselves. It is based on the ethical principle of respect for autonomy. Substitute decision-making poses two main questions: Who-should make the decision for the incapable person, and, How should the decision be made? Because the applicable statutory and common law varies across Canada, clinicians should become familiar with the legal requirements of their own province or territory.
Notes
Cites: J Am Geriatr Soc. 1994 Nov;42(11):1150-37963200
Cites: Ann Intern Med. 1995 Apr 1;122(7):514-207872587
Cites: JAMA. 1992 Apr 15;267(15):2067-711552642
Cites: CMAJ. 1994 Apr 15;150(8):1265-708162549
PubMed ID
8943932 View in PubMed
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Bioethics for clinicians: 7. Truth telling.

https://arctichealth.org/en/permalink/ahliterature209520
Source
CMAJ. 1997 Jan 15;156(2):225-8
Publication Type
Article
Date
Jan-15-1997
Author
P C Hébert
B. Hoffmaster
K C Glass
P A Singer
Author Affiliation
Department of Family and Community Medicine, University of Toronto, Ont.
Source
CMAJ. 1997 Jan 15;156(2):225-8
Date
Jan-15-1997
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Attitude to Health
Bioethics
Canada
Communication
Decision Making
Ethics, Medical
Humans
Informed consent
Patient Acceptance of Health Care
Patient Advocacy - legislation & jurisprudence
Patient Participation
Physician-Patient Relations
Quality of Life
Social Responsibility
Truth Disclosure
Abstract
The standard of professional candour with patients has undergone a significant change over the past 30 years. Independent of their obligation to disclose information necessary for informed consent, physicians are increasingly expected to communicate important information to patients that is not immediately related to treatment decisions. The purpose of truth telling is not simply to enable patients to make informed choices about health care and other aspects of their lives but also to inform them about their situation. Truth telling fosters trust in the medical profession and rests on the respect owed to patients as persons. It also prevents harm, as patients who are uninformed about their situation may fail to get medical help when they should.
PubMed ID
9012726 View in PubMed
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Bioethics for clinicians: 11. Euthanasia and assisted suicide.

https://arctichealth.org/en/permalink/ahliterature208428
Source
CMAJ. 1997 May 15;156(10):1405-8
Publication Type
Article
Date
May-15-1997
Author
J V Lavery
B M Dickens
J M Boyle
P A Singer
Author Affiliation
University of Toronto Joint Centre for Bioethics, Ont.
Source
CMAJ. 1997 May 15;156(10):1405-8
Date
May-15-1997
Language
English
Publication Type
Article
Keywords
Attitude to Health
Canada
Ethics, Medical
Euthanasia - legislation & jurisprudence
Euthanasia, Active
Euthanasia, Active, Voluntary
Humans
Intention
Internationality
Mental Competency
Personal Autonomy
Physician's Role
Stress, Psychological
Suicide, Assisted - legislation & jurisprudence
Terminal Care - legislation & jurisprudence - standards
Wedge Argument
Withholding Treatment
Abstract
Euthanasia and assisted suicide involve taking deliberate action to end or assist in ending the life of another person on compassionate grounds. There is considerable disagreement about the acceptability of these acts and about whether they are ethically distinct from decisions to forgo life-sustaining treatment. Euthanasia and assisted suicide are punishable offences under Canadian criminal law, despite increasing public pressure for a more permissive policy. Some Canadian physicians would be willing to practise euthanasia and assisted suicide if these acts were legal. In practice, physicians must differentiate between respecting competent decisions to forgo treatment, providing appropriate palliative care, and acceeding to a request for euthanasia or assisted suicide. Physicians who believe that euthanasia and assisted suicide should be legally accepted in Canada should pursue their convictions only through legal and democratic means.
Notes
Comment In: CMAJ. 1997 Sep 15;157(6):638, 6409307548
PubMed ID
9164399 View in PubMed
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Bioethics for clinicians: 15. Quality end-of-life care.

https://arctichealth.org/en/permalink/ahliterature204862
Source
CMAJ. 1998 Jul 28;159(2):159-62
Publication Type
Article
Date
Jul-28-1998
Author
P A Singer
N. MacDonald
Author Affiliation
University of Toronto Joint Centre for Bioethics, ON. peter.singer@utoronto.ca
Source
CMAJ. 1998 Jul 28;159(2):159-62
Date
Jul-28-1998
Language
English
Publication Type
Article
Keywords
Advance Care Planning
Bioethics
Canada
Clinical Medicine - legislation & jurisprudence - standards
Ethics, Medical
Euthanasia, Active
Humans
Quality of Health Care
Stress, Psychological
Terminal Care - legislation & jurisprudence - standards
Withholding Treatment
Abstract
A physician who receives a call from the emergency department to see a patient with heart failure will have a clear framework within which to approach this problem. The thesis of this article is that physicians do not have an analogous conceptual framework for approaching end-of-life care. The authors present and describe a framework for end-of-life care with 3 main elements: control of pain and other symptoms, the use of life-sustaining treatments and support of those who are dying and their families. This 3-part framework can be used by clinicians at the bedside to focus their effort in improving the quality of end-of-life care.
Notes
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Cites: Ann Intern Med. 1997 Jan 15;126(2):97-1069005760
PubMed ID
9700330 View in PubMed
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Bioethics for clinicians: 16. Dealing with demands for inappropriate treatment.

https://arctichealth.org/en/permalink/ahliterature204036
Source
CMAJ. 1998 Oct 6;159(7):817-21
Publication Type
Article
Date
Oct-6-1998
Author
C. Weijer
P A Singer
B M Dickens
S. Workman
Author Affiliation
Mount Sinai Hospital, Toronto, Ont. charles.weijer@dal.ca
Source
CMAJ. 1998 Oct 6;159(7):817-21
Date
Oct-6-1998
Language
English
Publication Type
Article
Keywords
Adult
Bioethics
Canada
Dissent and Disputes
Ethics, Medical
Female
Group Processes
Humans
Infant
Male
Medical Futility
Middle Aged
Patient Advocacy - legislation & jurisprudence
Persistent Vegetative State - therapy
Refusal to Treat - legislation & jurisprudence
Social Values
Withholding Treatment
Abstract
Demands by Patients or their Families for treatment thought to be inappropriate by health care providers constitute an important set of moral problems in clinical practice. A variety of approaches to such cases have been described in the literature, including medical futility, standard of care and negotiation. Medical futility fails because it confounds morally distinct cases: demand for an ineffective treatment and demand for an effective treatment that supports a controversial end (e.g., permanent unconsciousness). Medical futility is not necessary in the first case and is harmful in the second. Ineffective treatment falls outside the standard of care, and thus health care workers have no obligation to provide it. Demands for treatment that supports controversial ends are difficult cases best addressed through open communication, negotiation and the use of conflict-resolution techniques. Institutions should ensure that fair and unambiguous procedures for dealing with such cases are laid out in policy statements.
Notes
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Comment In: CMAJ. 1999 Feb 9;160(3):309-1010065067
PubMed ID
9805031 View in PubMed
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38 records – page 1 of 4.