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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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Advance directives for resuscitation and other life-saving or sustaining measures.

https://arctichealth.org/en/permalink/ahliterature224132
Source
CMAJ. 1992 Mar 15;146(6):1072A-B
Publication Type
Article
Date
Mar-15-1992

Advance orders to limit therapy in 67 long-term care facilities in Finland.

https://arctichealth.org/en/permalink/ahliterature179892
Source
Resuscitation. 2004 Jun;61(3):333-9
Publication Type
Article
Date
Jun-2004
Author
Marja-Liisa Laakkonen
U Harriet Finne-Soveri
Anja Noro
Reijo S Tilvis
Kaisu H Pitkala
Author Affiliation
Helsinki City Hospital Koskela, P.O. Box 6410, FIN-00099 Helsinki, Finland. marja-liisa.laakkonen@hel.fi
Source
Resuscitation. 2004 Jun;61(3):333-9
Date
Jun-2004
Language
English
Publication Type
Article
Keywords
Advance Directives - statistics & numerical data
Aged
Aged, 80 and over
Assisted Living Facilities
Female
Finland
Hospitalization
Hospitals, Chronic Disease
Humans
Living Wills
Long-Term Care
Male
Nursing Homes
Resuscitation Orders
Abstract
To assess the documentation of a do-not-attempt-resuscitation (DNAR) or do-not-hospitalize (DNH) orders in the medical record and to determine factors related to these orders.
Five thousand six hundred and fifty four subjects from three different levels of institutional long-term care (LTC), chronic care hospitals (n = 1989), nursing homes (n = 3310), and assisted living (n = 335) in 67 LTC facilities in 19 municipalities were assessed.
Out of these patients, 751 (13%) had a DNAR order and only 36 (0.6%) had a DNH order. The variation in DNAR orders between individual LTC institutions was enormous, ranging from 0 to 92%. In logistic regression analysis, individual institutions and their local caring cultures had the strongest explanatory value (R(2) = 0.49) for advance orders to limit therapy. Impaired activity in daily living (ADL) function (R(2) = 0.11), impaired cognition (R(2) = 0.07), level of LTC (R(2) = 0.05), and diagnoses (R(2) = 0.04) did not provide adequate explanations. Terminal prognosis was not significantly associated with advance orders.
We found marked differences in the use of DNAR and DNH orders between caring units. Diseases and ADL status were only weakly significant as background factors. Open discussions, general guidelines, and research about the adequacy of DNAR decisions are needed to improve equality and self-empowerment among the elderly residing in institutions.
PubMed ID
15172713 View in PubMed
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Agreement on disease-specific criteria for do-not-resuscitate orders in acute stroke. Members of the Canadian and Western New York Stroke Consortiums.

https://arctichealth.org/en/permalink/ahliterature212814
Source
Stroke. 1996 Feb;27(2):232-7
Publication Type
Article
Date
Feb-1996
Author
A V Alexandrov
P M Pullicino
E M Meslin
J W Norris
Author Affiliation
Department of Neurology, Buffalo General Hospital, State University of New York, USA.
Source
Stroke. 1996 Feb;27(2):232-7
Date
Feb-1996
Language
English
Publication Type
Article
Keywords
Acute Disease
Brain Damage, Chronic
Brain diseases
Canada
Cerebrovascular Disorders - mortality - nursing - physiopathology
Consensus
Ethics, Medical
Ethics, Nursing
Guidelines as Topic
Humans
New York
Patient care team
Patient Selection
Physicians
Professional-Family Relations
Prognosis
Resuscitation Orders
Withholding Treatment
Abstract
The do-not-resuscitate (DNR) order is a mechanism of withholding cardiopulmonary resuscitation (CPR). The lack of DNR guidelines specific for acute stroke may result in many stroke patients receiving unnecessary and futile resuscitation and ventilator-assisted breathing.
A prospective multicenter evaluation of disease-specific criteria for DNR orders in acute stroke was initiated using a modified Delphi process. The participants were the Canadian and Western New York Stroke Consortium members who are closely involved in caring for acute stroke patients and conducting clinical trials at the academic centers. Previously published provisional criteria were reviewed by the participants. Modifications were made to the criteria until statistically significant agreement (P
PubMed ID
8571415 View in PubMed
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[A medical controversy on treatment withdrawal. Does the physician risk to be charged for killing? Only if he deviates from the medical society consensus].

https://arctichealth.org/en/permalink/ahliterature226515
Source
Lakartidningen. 1991 Apr 10;88(15):1417-20
Publication Type
Article
Date
Apr-10-1991

Article: Comparison of CMA Joint Statement on resuscitative interventions and New Brunswick Hospital Corporations' policies on end-of-life treatments. Poirier N. J Palliat Care 2000; 16(1): 15-22.

https://arctichealth.org/en/permalink/ahliterature197024
Source
J Palliat Care. 2000;16(3):55-7
Publication Type
Article
Date
2000
Author
J R Williams
Source
J Palliat Care. 2000;16(3):55-7
Date
2000
Language
English
Publication Type
Article
Keywords
Canada
Humans
Practice Guidelines as Topic - standards
Resuscitation Orders
Societies, Medical
Terminal Care - standards
Notes
Comment On: J Palliat Care. 2000 Spring;16(1):15-2210802959
PubMed ID
11019508 View in PubMed
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Attitudes of Canadian neonatologists in delivery room resuscitation of newborns at threshold of viability.

https://arctichealth.org/en/permalink/ahliterature161500
Source
J Obstet Gynaecol Can. 2007 Sep;29(9):719-25
Publication Type
Article
Date
Sep-2007
Author
Pascal M Lavoie
Yaron Keidar
Susan Albersheim
Author Affiliation
Division of Neonatology, Department of Pediatrics, Children's and Women's Health Centre of British Columbia, Vancouver, BC.
Source
J Obstet Gynaecol Can. 2007 Sep;29(9):719-25
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude of Health Personnel
Canada
Female
Fetal Viability
Gestational Age
Humans
Infant, Newborn
Infant, Premature
Male
Middle Aged
Neonatology
Resuscitation Orders
Withholding Treatment
Abstract
There is great debate regarding the extent of intensive care interventions for extremely premature newborns. In this report, we describe Canadian neonatologists' attitudes towards delivery room resuscitation decisions in neonates at the threshold of viability.
We interviewed neonatologists (N = 121) practising in Canadian tertiary care neonatal units between June 2004 and April 2005, and asked whether they would support a parental request not to initiate resuscitation for newborns of 23 to 26 weeks' gestation. Bivariate analyses were performed to identify sociodemographic or cultural factors that might affect resuscitation decisions.
Most Canadian neonatologists would support a parental request not to initiate resuscitation of an infant at 23 and 24 weeks' gestation (98% and 80%, respectively). However, we observed heterogeneity across the country in attitudes primarily at 25 weeks, but also at 24 weeks' gestation. At 24 weeks' gestation, decisions also appear to be significantly related to personal experience with a disabled close friend or relative. For newborns of 25 weeks' gestation, neonatologists are divided: a majority (76%) would strongly advocate resuscitation and/or resuscitate a "viable" fetus against parental wishes, and a minority (24%) would agree not to initiate treatment. At 26 weeks' gestation, more than 97% would not support a request not to initiate resuscitation.
Attitudes of Canadian neonatologists towards resuscitation of newborns at the threshold of viability primarily differ at 25 weeks and to a lesser extent at 24 weeks of gestation. Our findings highlight important nuances in relation to existing national guidelines.
PubMed ID
17825136 View in PubMed
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Attitudinal patterns determining decision-making in severely ill elderly patients: a cross-cultural comparison between nurses from Sweden and Germany.

https://arctichealth.org/en/permalink/ahliterature71901
Source
Int J Nurs Stud. 2001 Aug;38(4):381-8
Publication Type
Article
Date
Aug-2001
Author
J. Richter
M R Eisemann
Author Affiliation
Department and University Hospital of Psychiatry and Psychotherapy, Rostock University, Gehlsheimer Str. 20, 18147 Rostock, Germany. joerg.richter@med.uni-rostock.de
Source
Int J Nurs Stud. 2001 Aug;38(4):381-8
Date
Aug-2001
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adult
Advance Directives
Age Factors
Aged
Aged, 80 and over
Attitude of Health Personnel - ethnology
Cardiopulmonary Resuscitation
Comparative Study
Cross-Cultural Comparison
Decision Making
Dementia - classification - complications - therapy
Ethics, Nursing
Female
Geriatric Assessment
Germany
Health Knowledge, Attitudes, Practice
Humans
Male
Mental Competency
Middle Aged
Nursing Staff, Hospital - education - psychology
Patient Advocacy
Questionnaires
Resuscitation Orders
Severity of Illness Index
Sweden
Abstract
To explain determinants in the decision-making of nurses in the treatment of severely ill incompetent patients and to describe underlying attitudes, consecutive samples of nurses from Germany and Sweden have been investigated by means of a case scenario and a questionnaire. Whereas the level of dementia emerged as the only factor being significantly related with the treatment option within the Swedish group, patient's age, patient's wishes and ethical concerns were correlated among German nurses. The more the nurses have been able to participate in the provision of the available do-not-resuscitate order or of an advance directive, the less frequent they would perform CPR against the patient's wishes.
PubMed ID
11470096 View in PubMed
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[Before and after implementation of do-not-resuscitate orders in a stroke unit]

https://arctichealth.org/en/permalink/ahliterature90736
Source
Tidsskr Nor Laegeforen. 2008 Dec 18;128(24):2819-22
Publication Type
Article
Date
Dec-18-2008
Author
Mjåset Christer
Gulbrandsen Pål
Rønning Ole Morten
Thommessen Bente
Author Affiliation
Nevrologisk avdeling Akershus universitetssykehus 1478 Lørenskog. chmja@online.no
Source
Tidsskr Nor Laegeforen. 2008 Dec 18;128(24):2819-22
Date
Dec-18-2008
Language
Norwegian
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Hospital Mortality
Humans
Male
Norway - epidemiology
Outcome Assessment (Health Care)
Prognosis
Resuscitation Orders
Stroke - diagnosis - mortality - therapy
Withholding Treatment
Abstract
BACKGROUND: In Norway, few studies have been done to map the extent of do-not-resuscitate (DNR) orders and the consequence for patients (treatment and outcome). MATERIAL AND METHODS: All patients with DNR orders, referred to the stroke unit of Akershus University Hospital during the year 2005, were identified and data on treatment and outcome were recorded. RESULTS: A DNR order was found for 79 of 855 (9 %) patients (mean age 80 years [SD 9]). Reasons for referral to hospital were: cerebral infarction (49 [62 %] patients), intracerebral haemorrhage (28 [35 %] patients), and other diseases (2 [3 %] patients). Mean NIH Stroke Scale was 19 (SD 6) (scale 0 - 42; 0 in score meaning no stroke related symptoms). Hospital mortality was 39/79 (49 %). Apart from once, all decisions regarding withholding and/or withdrawing life-sustaining treatment were taken in the aftermath of a DNR order. For 43 patients (54 %), treatment was limited in some way and hospital mortality for this group was 27/43 (63 %). Mortality was 12/36 (33 %) for those who had full treatment. 45 patients (57 %) with a DNR order had a bacterial infection and 32 of them were treated with antibiotics (71 %). INTERPRETATION: Patients with DNR orders were old and had had severe stroke. Treatment was rarely withheld despite high morbidity and mortality among the patients.
Notes
Comment In: Tidsskr Nor Laegeforen. 2009 Feb 12;129(4):31019219101
PubMed ID
19092948 View in PubMed
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168 records – page 1 of 17.