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Accounting for vulnerability to illness and social disadvantage in pandemic critical care triage.

https://arctichealth.org/en/permalink/ahliterature96997
Source
J Clin Ethics. 2010;21(1):23-9
Publication Type
Article
Date
2010
Author
Chris Kaposy
Author Affiliation
Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada. christopher.kaposy@med.mun.ca
Source
J Clin Ethics. 2010;21(1):23-9
Date
2010
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Critical Care
Cultural Characteristics
Disaster Planning - trends
Disease Outbreaks
Health Care Rationing - ethics
Health Policy - trends
Humans
Indians, North American - statistics & numerical data
Influenza A Virus, H1N1 Subtype - isolation & purification
Influenza, Human - ethnology - mortality - virology
Intensive Care Units - organization & administration - standards
Inuits - statistics & numerical data
Newfoundland and Labrador - epidemiology
Patient Selection - ethics
Prognosis
Risk assessment
Social Class
Triage - methods - organization & administration - standards - trends
Vulnerable Populations
Abstract
In a pandemic situation, resources in intensive care units may be stretched to the breaking point, and critical care triage may become necessary. In such a situation, I argue that a patient's combined vulnerability to illness and social disadvantage should be a justification for giving that patient some priority for critical care. In this article I present an example of a critical care triage protocol that recognizes the moral relevance of vulnerability to illness and social disadvantage, from the Canadian province of Newfoundland and Labrador.
PubMed ID
20465071 View in PubMed
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Action ethical dilemmas in surgery: an interview study of practicing surgeons.

https://arctichealth.org/en/permalink/ahliterature51843
Source
BMC Med Ethics. 2005 Jul 4;6:E7
Publication Type
Article
Date
Jul-4-2005
Author
Kirsti Torjuul
Ann Nordam
Venke Sørlie
Author Affiliation
Sør-Trøndelag University College, Faculty of Nursing, Trondheim, Norway. kirsti.torjuul@hist.no.
Source
BMC Med Ethics. 2005 Jul 4;6:E7
Date
Jul-4-2005
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Ethics, Clinical
Health Care Rationing - ethics
Humans
Informed Consent - ethics
Interprofessional Relations
Interviews
Narration
Norway
Physician Impairment
Physician-Patient Relations - ethics
Physicians - ethics - psychology
Resuscitation Orders - legislation & jurisprudence
Surgery - ethics
Waiting Lists
Withholding Treatment - ethics
Abstract
BACKGROUND: The aim of this study was to describe the kinds of ethical dilemmas surgeons face during practice. METHODS: Five male and five female surgeons at a University hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of physicians and nurses about ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. RESULTS: No gender differences were found in the kinds of ethical dilemmas identified among male and female surgeons. The main finding was that surgeons experienced ethical dilemmas in deciding the right treatment in different situations. The dilemmas included starting or withholding treatment, continuing or withdrawing treatment, overtreatment, respecting the patients and meeting patients' expectations. The main focus in the narratives was on ethical dilemmas concerning the patients' well-being, treatment and care. The surgeons narrated about whether they should act according to their own convictions or according to the opinions of principal colleagues or colleagues from other departments. Handling incompetent colleagues was also seen as an ethical dilemma. Prioritization of limited resources and following social laws and regulations represented ethical dilemmas when they contradicted what the surgeons considered was in the patients' best interests. CONCLUSION: The surgeons seemed confident in their professional role although the many ethical dilemmas they experienced in trying to meet the expectations of patients, colleagues and society also made them professionally and personally vulnerable.
PubMed ID
15996268 View in PubMed
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Appeals to individual responsibility for health--reconsidering the luck egalitarian perspective.

https://arctichealth.org/en/permalink/ahliterature115446
Source
Camb Q Healthc Ethics. 2013 Apr;22(2):146-58
Publication Type
Article
Date
Apr-2013

Balancing relevant criteria in allocating scarce life-saving interventions.

https://arctichealth.org/en/permalink/ahliterature97418
Source
Am J Bioeth. 2010 Apr;10(4):56-8
Publication Type
Article
Date
Apr-2010
Author
Erik Nord
Author Affiliation
Department of Mental Health, Norwegian Institute of Public Health, Oslo, 1403, Norway. erik.nord@fhi.no
Source
Am J Bioeth. 2010 Apr;10(4):56-8
Date
Apr-2010
Language
English
Geographic Location
Norway
Multi-National
Publication Type
Article
Keywords
Adolescent
Adult
Aging
Decision Making - ethics
Great Britain
Health Care Rationing - ethics
Humans
Infant
Life expectancy
Morals
Norway
Patient Selection - ethics
Prognosis
Quality-Adjusted Life Years
Social Justice
Social Values
Young Adult
Notes
RefSource: Am J Bioeth. 2010 Apr;10(4):37-45
PubMed ID
20379926 View in PubMed
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Source
Camb Q Healthc Ethics. 2013 Apr;22(2):159-69
Publication Type
Article
Date
Apr-2013

Can a moral reasoning exercise improve response quality to surveys of healthcare priorities?

https://arctichealth.org/en/permalink/ahliterature153532
Source
J Med Ethics. 2009 Jan;35(1):57-64
Publication Type
Article
Date
Jan-2009
Author
M. Johri
L J Damschroder
B J Zikmund-Fisher
S Y H Kim
P A Ubel
Author Affiliation
Department of Health Administration, Faculté de Médicine, Université de Montréal, CP 6128, Succ. Centre-Ville, Montréal, Quebec, Canada H3C3J7. mira.johri@umontreal.ca
Source
J Med Ethics. 2009 Jan;35(1):57-64
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Canada
Decision Making - ethics
Female
Health Care Rationing - ethics
Health Care Surveys
Health Priorities - ethics
Humans
Internet
Male
Public Opinion
Questionnaires
United States
Abstract
To determine whether a moral reasoning exercise can improve response quality to surveys of healthcare priorities
A randomised internet survey focussing on patient age in healthcare allocation was repeated twice. From 2574 internet panel members from the USA and Canada, 2020 (79%) completed the baseline survey and 1247 (62%) completed the follow-up. We elicited respondent preferences for age via five allocation scenarios. In each scenario, a hypothetical health planner made a decision to fund one of two programmes identical except for average patient age (35 vs 65 years). Half of the respondents (intervention group) were randomly assigned to receive an additional moral reasoning exercise. Responses were elicited again 7 weeks later. Numerical scores ranging from -5 (strongest preference for younger patients) to +5 (strongest preference for older patients); 0 indicates no age preference. Response quality was assessed by propensity to choose extreme or neutral values, internal consistency, temporal stability and appeal to prejudicial factors.
With the exception of a scenario offering palliative care, respondents preferred offering scarce resources to younger patients in all clinical contexts. This preference for younger patients was weaker in the intervention group. Indicators of response quality favoured the intervention group.
Although people generally prefer allocating scarce resources to young patients over older ones, these preferences are significantly reduced when participants are encouraged to reflect carefully on a wide range of moral principles. A moral reasoning exercise is a promising strategy to improve response quality to surveys of healthcare priorities.
PubMed ID
19103946 View in PubMed
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Source
Am J Bioeth. 2010 Mar;10(3):56-7
Publication Type
Article
Date
Mar-2010

The case of Samuel Golubchuk and the right to live.

https://arctichealth.org/en/permalink/ahliterature144877
Source
Am J Bioeth. 2010 Mar;10(3):50-3
Publication Type
Article
Date
Mar-2010
Author
Alan Jotkowitz
Shimon Glick
Ari Z Zivotofsky
Author Affiliation
Ben-Gurion University of the Negev, Beer-Sheva, Israel. ajotkowitz@hotmail.com
Source
Am J Bioeth. 2010 Mar;10(3):50-3
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Canada
Choice Behavior - ethics
Cultural Characteristics
Decision Making - ethics
Dissent and Disputes
Enteral Nutrition - ethics
Ethics, Clinical
Ethics, Medical
Freedom
Health Care Rationing - ethics
Humans
Jews
Life expectancy
Life Support Care - ethics
Male
Manitoba
Medical Futility - ethics
Persistent Vegetative State
Personal Autonomy
Physician's Role
Practice Guidelines as Topic
Societies, Medical
Terminal Care - ethics - methods
Terminally ill
Value of Life
Withholding Treatment - ethics
Abstract
Samuel Golubchuk was unwittingly at the center of a medical controversy with important ethical ramifications. Mr. Golubchuk, an 84-year-old patient whose precise neurological level of function was open to debate, was being artificially ventilated and fed by a gastrostomy tube prior to his death. According to all reports he was neither brain dead nor in a vegetative state. The physicians directly responsible for his care had requested that they be allowed to remove the patient from life support against the wishes of the patient's family. Concurrently the Manitoba College of Physicians and Surgeons released a statement which states that the final decision to withdraw life support lies with the physician. In our opinion the statement is ethically problematic for a number of reasons. 1. It is an affront to the guiding principles of Western medical ethics: patient autonomy and human freedom. 2. The position of Samuel Golubchuk's physicians and the new statement lack cultural sensitivity towards other traditions. 3. In modern society there exists an erosion of a basic attitude towards the value of life. 4. The ability of physicians to predict life expectancy in terminally ill patients has been shown repeatedly to be quite limited.
Notes
Comment In: Am J Bioeth. 2010 Mar;10(3):56-720229423
Comment In: Am J Bioeth. 2010 Mar;10(3):54-620229422
Comment In: Am J Bioeth. 2010 Mar;10(3):67-820229429
Comment In: Am J Bioeth. 2010 Mar;10(3):64-520229427
Comment In: Am J Bioeth. 2010 Mar;10(3):61-320229426
Comment In: Am J Bioeth. 2010 Mar;10(3):W6-720229404
Comment In: Am J Bioeth. 2010 Mar;10(3):73-420229432
Comment In: Am J Bioeth. 2010 Mar;10(3):69-7020229430
Comment In: Am J Bioeth. 2010 Mar;10(3):58-920229424
Comment In: Am J Bioeth. 2010 Mar;10(3):65-620229428
Comment In: Am J Bioeth. 2010 Mar;10(3):59-6120229425
Comment In: Am J Bioeth. 2010 Mar;10(3):71-320229431
PubMed ID
20229421 View in PubMed
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Clinical prioritisations of healthcare for the aged--professional roles.

https://arctichealth.org/en/permalink/ahliterature93251
Source
J Med Ethics. 2008 May;34(5):332-5
Publication Type
Article
Date
May-2008
Author
Nortvedt P.
Pedersen R.
Grøthe K H
Nordhaug M.
Kirkevold M.
Slettebø A.
Brinchmann B S
Andersen B.
Author Affiliation
Department of General Practice and Community Medicine, Section for Medical Ethics, University of Oslo, PO Box 1130 Blindern, NO-0318 Oslo, Norway. p.nortvedt@medisin.uio.no
Source
J Med Ethics. 2008 May;34(5):332-5
Date
May-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude of Health Personnel
Female
Health Care Rationing - ethics
Health Services for the Aged - ethics - standards - supply & distribution
Humans
Interviews as Topic
Male
Medical Staff
Middle Aged
Norway
Nursing Staff
Professional Role - psychology
Professional-Patient Relations - ethics
Qualitative Research
Abstract
BACKGROUND: Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians' considerations in clinical prioritisation within this field is scarce. OBJECTIVES: To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients. DESIGN: A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis. PARTICIPANTS: 20 physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway. Results and INTERPRETATIONS: The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians' role. CONCLUSION: Distributing healthcare services in a fair way is generally not described as integral to the clinicians' role in clinical prioritisations. If considerations of justice are not included in clinicians' role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions.
PubMed ID
18448710 View in PubMed
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42 records – page 1 of 5.