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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
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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
Less detail

Bioethics for clinicians: 17. Conflict of interest in research, education and patient care.

https://arctichealth.org/en/permalink/ahliterature203787
Source
CMAJ. 1998 Oct 20;159(8):960-5
Publication Type
Article
Date
Oct-20-1998
Author
T. Lemmens
P A Singer
Author Affiliation
Centre for Addiction and Mental Health, Toronto, Ont. trudo.lemmens@utoronto.ca
Source
CMAJ. 1998 Oct 20;159(8):960-5
Date
Oct-20-1998
Language
English
Publication Type
Article
Keywords
Bioethics
Biomedical research
Canada
Conflict of Interest
Disclosure
Education, Medical - legislation & jurisprudence - standards
Empirical Research
Ethics, Medical
Gift Giving
Health Policy
Humans
Patient Care - standards
Research - legislation & jurisprudence - standards
Social Control, Formal
Trust
Truth Disclosure
Abstract
A conflict of interest occurs in a situation in which professional judgement regarding a primary interest, such as research, education or patient care, may be unduly influenced by a secondary interest, such as financial gain or personal prestige. Conflicts of interest exist in every walk of life, including medicine and science. There is nothing inherently unethical in finding oneself in a conflict of interest. Rather, the key questions are whether one recognizes the conflict and how one deals with it. Strategies include disclosing the conflict, establishing a system of review and authorization, and prohibiting the activities that lead to the conflict.
Notes
Cites: Can J Psychiatry. 1997 Sep;42(7):764-709307838
Cites: JAMA. 1998 Apr 1;279(13):1031-29533505
Cites: JAMA. 1998 Apr 1;279(13):995-99533497
Cites: N Engl J Med. 1998 Jan 8;338(2):101-69420342
Cites: CMAJ. 1997 Nov 15;157(10):1373-49371067
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Cites: CMAJ. 1997 Feb 1;156(3):351-69033415
Cites: CMAJ. 1996 Nov 1;155(9):1243-88911290
Cites: CMAJ. 1996 Jun 1;154(11):1744-68646666
Cites: Am J Law Med. 1995;21(2-3):259-808571978
Cites: CMAJ. 1995 Sep 1;153(5):553-97641153
Cites: CMAJ. 1995 Aug 15;153(4):398-97634216
Cites: CMAJ. 1994 Nov 1;151(9):1320-27954182
Cites: CMAJ. 1994 Mar 15;150(6):951-38131127
Cites: CMAJ. 1993 Nov 15;149(10):1401-78221424
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Cites: J Gen Intern Med. 1998 Mar;13(3):151-49541370
Comment In: CMAJ. 1999 Mar 23;160(6):78410189418
PubMed ID
9834723 View in PubMed
Less detail

HIV-seropositive surgeons: informed consent and public health policy.

https://arctichealth.org/en/permalink/ahliterature223537
Source
CMAJ. 1992 Jul 1;147(1):29-31
Publication Type
Article
Date
Jul-1-1992
Author
J G Wright
P A Singer
Source
CMAJ. 1992 Jul 1;147(1):29-31
Date
Jul-1-1992
Language
English
Publication Type
Article
Keywords
Canada
General Surgery
HIV Infections - transmission
HIV Seropositivity
Health Policy
Humans
Informed Consent - legislation & jurisprudence
Public Health
Notes
Cites: JAMA. 1991 Aug 14;266(6):803-91907669
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Comment In: CMAJ. 1993 May 1;148(9):1445-68477359
Comment In: CMAJ. 1993 May 1;148(9):1445; author reply 14468477358
PubMed ID
1393884 View in PubMed
Less detail

Hospital policies on life-sustaining treatments and advance directives in Canada.

https://arctichealth.org/en/permalink/ahliterature218351
Source
CMAJ. 1994 Apr 15;150(8):1265-70
Publication Type
Article
Date
Apr-15-1994
Author
I. Rasooly
J V Lavery
S. Urowitz
S. Choudhry
N. Seeman
E M Meslin
F H Lowy
P A Singer
Author Affiliation
Centre for Bioethics, University of Toronto, Ont.
Source
CMAJ. 1994 Apr 15;150(8):1265-70
Date
Apr-15-1994
Language
English
Publication Type
Article
Keywords
Attitude to Health
Canada
Cross-Sectional Studies
Health Policy
Hospitals - trends
Humans
Questionnaires
Resuscitation Orders
Abstract
To determine the prevalence and content of hospital policies on life-sustaining treatments (cardiopulmonary resuscitation [CPR], mechanical ventilation, dialysis, artificial nutrition and hydration, and antibiotic therapy for life-threatening infections) and advance directives in Canada.
Cross-sectional mailed survey.
Canada.
Chief executive officers or their designates at public general hospitals.
Information regarding the existence of policies on life-sustaining treatments or advance directives and the content of the policies.
Questionnaires were completed for 697 (79.2%) of the 880 hospitals surveyed. Of the 697 respondents 362 (51.9%) sent 388 policies; 355 (50.9%) sent do-not-resuscitate (DNR) policies (i.e., policies that addressed CPR alone or in combination with other life-sustaining treatments). Of the 388 policies 327 (84.3%) addressed CPR alone, 28 (7.2%) addressed CPR plus other life-sustaining treatments, 10 (2.6%) addressed advance directives, and the remaining 23 (5.9%) addressed other life-sustaining treatments. Of the 355 DNR policies 1 (0.3%) stated that routine discussion with patients is required, 315 (88.7%) restricted their scope to terminally or hopelessly ill patients, 187 (52.7%) mentioned futility, 29 (8.2%) mentioned conflict resolution, 9 (2.5%) and 13 (3.7%) required explicit communication of the decision to the competent patient or family of the incompetent patient respectively, 110 (31.0%) authorized the family of an incompetent patient to rescind the DNR order, 224 (63.1%) authorized the nursing staff to do so, and 217 (61.1%) authorized physicians to do so.
Although about half of the public general hospitals surveyed had DNR policies few had policies regarding other life-sustaining treatments or advance directives. Existing policies could be improved if hospitals encouraged routine advance discussions, removed the restriction to terminally or hopelessly ill patients, scrutinized the use of the futility standard, stipulated procedures for conflict resolution, explicitly required communication of the decision to competent patients or substitute decision-makers of incompetent patients and scrutinized the provision allowing families and health care professionals to rescind the wishes of now incompetent patients.
Notes
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Cites: N Engl J Med. 1984 Apr 26;310(17):1115-66708993
PubMed ID
8162549 View in PubMed
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Priority setting for new technologies in medicine: qualitative case study.

https://arctichealth.org/en/permalink/ahliterature196528
Source
BMJ. 2000 Nov 25;321(7272):1316-8
Publication Type
Article
Date
Nov-25-2000
Author
P A Singer
D K Martin
M. Giacomini
L. Purdy
Author Affiliation
University of Toronto Joint Centre for Bioethics, Toronto, ON, Canada M5G 1L4. peter.singer@utoronto.ca
Source
BMJ. 2000 Nov 25;321(7272):1316-8
Date
Nov-25-2000
Language
English
Publication Type
Article
Keywords
Costs and Cost Analysis
Decision Making, Organizational
Empirical Research
Health Expenditures
Health Policy
Health Priorities - organization & administration
Heart Diseases - economics - therapy
Humans
Neoplasms - economics - therapy
Ontario
Organizational Case Studies
Professional Staff Committees
Qualitative Research
Technology Assessment, Biomedical - economics - organization & administration
Abstract
To describe priority setting for new technologies in medicine.
Qualitative study using case studies and grounded theory.
Two committees advising on priorities for new technologies in cancer and cardiac care in Ontario, Canada.
The two committees and their 26 members.
Accounts of priority setting decision making gathered by reviewing documents, interviewing members, and observing meetings.
Six interrelated domains were identified for priority setting for new technologies in medicine: the institutions in which the decision are made, the people who make the decisions, the factors they consider, the reasons for the decisions, the process of decision making, and the appeals mechanism for challenging the decisions.
These domains constitute a model of priority setting for new technologies in medicine. The next step will be to harmonise this description of how priority setting decisions are made with ethical accounts of how they should be made.
Notes
Cites: Hastings Cent Rep. 1998 Mar-Apr;28(2):27-419589291
Cites: BMJ. 1999 Nov 6;319(7219):1258-6110550097
Cites: Philos Public Aff. 1997 Fall;26(4):303-5011660435
Cites: J Econ Perspect. 1992 Summer;6(3):3-2110128078
Cites: Health Policy. 1997 Oct;42(1):49-6610173493
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Cites: BMJ. 1999 Aug 14;319(7207):418-2110445924
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Cites: BMJ. 1999 Feb 13;318(7181):456-99974468
Comment In: BMJ. 2000 Nov 25;321(7272):1300-111090498
PubMed ID
11090513 View in PubMed
Less detail