Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper

Ann Intern Med. 2017;167(8):576-578.
Authors: Lois Snyder Sulmasy, Paul S. Mueller; for the Ethics, Professionalism and Human Rights Committee of the American College of Physicians
“Calls to legalize physician-assisted suicide have increased and public interest in the subject has grown in recent years despite ethical prohibitions. Many people have concerns about how they will die and the emphasis by medicine and society on intervention and cure has sometimes come at the expense of good end-of-life care. Some have advocated strongly, on the basis of autonomy, that physician-assisted suicide should be a legal option at the end of life. As a proponent of patient-centered care, the American College of Physicians (ACP) is attentive to all voices, including those who speak of the desire to control when and how life will end. However, the ACP believes that the ethical arguments against legalizing physician-assisted suicide remain the most compelling.”
Find position paper here.

Has the right to breach patient confidentiality created a common law duty to warn genetic relatives?

QUT Law Review Volume 17, Issue 1, pp.147–159
Author: Wendy Nixon
“This paper discusses the conflict between a medical practitioner’s duty of care and duty to maintain patient confidentiality, and their statutory right to inform a relative about a possible genetic condition. The statutory right arguably creates a Rogers v Whitaker type duty to provide the same information a patient might require in order to make informed choices about testing and treatment. In the event that reasonable clinical judgment is not applied to disclosure, the genetic relative ought to be offered the opportunity to seek redress through the common law if they suffer harm as a result.”
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Let us talk about eggs! Professional resistance to elective egg vitrification and gendered medical paternalism

Med Health Care and Philos (2017), p1-13
Authors: Judit Sándor, Lilla Vicsek, Zsófia Bauer
“In this paper, by applying a feminist bioethical perspective, we identify a new form of medical paternalism that still shapes contemporary legal policies on human egg cryopreservation performed without medical reasons. The fear of negligent, careless women who opt to delay their pregnancy for mere convenience is a widely known gender biased stereotype. Nevertheless, the opinions and judgments of medical professionals on this issue have not yet been sufficiently explored by in-depth research. In this essay, therefore, first we look at the broader bioethical, legal, and social aspects of human egg cryopreservation. In the second part of the paper we discuss a unique qualitative study conducted with professionals working at Hungarian IVF clinics.”
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Misdirections in Informed Consent — Impediments to Health Care Innovation

N Engl J Med 2017; 377:1412-1414
Authors: David A. Asch, Tracy A. Ziolek, Shivan J. Mehta
“A large literature on research consent aims to prevent these problems, offering ethical analyses that are more forgiving of waivers of consent than what many investigators hear from their IRBs. Indeed, so many ethicists may have weighed in on this issue not because the ethics are disputed, but because overgeneralizations of research conventions persist despite the published literature. The QRS plan is instructive in part because it seems so obviously acceptable; yet IRBs are left to define “practicability” and “adverse effects on rights and welfare.” In doing so, they are susceptible to predictable sources of misdirection. Trials of substantially greater consequence — for example, those focused on critically ill patients — face greater obstacles.”
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A Prospectus for ethical analysis of ageing individuals’ responsibility to prevent cognitive decline

Bioethics, 2017;00:1–9
Authors: Cynthia Forlini, Wayne Hall
“Ethical tensions arise when this individual responsibility collides with social and personal realities of ageing populations. First, we contextualize the priority given to healthy cognitive ageing within the current brain-based medical and social discourses. Second, we explore the individual responsibility by examining the economic considerations, medical evidence and individual interests that relate to the priority given to healthy cognitive ageing. Third, we identify three key ethical challenges for policymakers seeking to implement lifestyle recommendations as an effective population-level approach to healthy cognitive ageing. The result is a prospectus for future in-depth analysis of ethical tensions that arise from current policy discussions of healthy cognitive ageing.”
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When surgeons unwittingly don’t obtain informed consent

The BMJ Opinion, 6 October 2017
Authors: Fraser Smith and David Locke
“It is our belief that many patients with rectal cancer are (probably unwittingly) not being informed about potential treatment options which may be available to them that could allow them to avoid radical surgery and a stoma. In effect this is rendering informed consent invalid and represents a failure to safeguard patient autonomy.”
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Aid-in-dying laws and the physician’s duty to inform

Journal of Medical Ethics 2017; 43: 666-669.
Author: Mara Buchbinder
“On 19 July 2016, three medical organisations filed a federal lawsuit against representatives from several Vermont agencies over the Patient Choice and Control at End of Life Act. The law is similar to aid-in-dying (AID) laws in four other US states, but the lawsuit hinges on a distinctive aspect of Vermont’s law pertaining to patients’ rights to information. The lawsuit raises questions about whether, and under what circumstances, there is an ethical obligation to inform terminally ill patients about AID as an end-of-life option. Much of the literature on clinical communication about AID addresses how physicians should respond to patient requests for assisted dying, but neglects the question of how physicians should approach patients who may not know enough about AID to request it.”
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Ethics of patient activation: exploring its relation to personal responsibility, autonomy and health disparities

Journal of Medical Ethics 2017; 43: 670-675.
Authors: Sophia H Gibert, David DeGrazia, Marion Danis
“Discussions of patient-centred care and patient autonomy in bioethics have tended to focus on the decision-making context and the process of obtaining informed consent, leaving open the question of how patients ought to be counselled in the daily maintenance of their health and management of chronic disease. Patient activation is an increasingly prominent counselling approach and measurement tool that aims to improve patients’ confidence and skills in managing their own health conditions. The strategy, which has received little conceptual or ethical analysis, raises important questions about how clinicians ought to foster confidence and a sense of control in their patients without exposing them to blame, stigma and other harms. In this paper, we describe patient activation, discuss its relationship to personal responsibility, autonomy and health disparities, and make recommendations regarding its use and measurement.”
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Informed Consent to Study Purpose in Randomized Clinical Trials of Antibiotics, 1991 Through 2011

JAMA Intern Med. 2017; 177(10): 1-8.
Authors: Peter Doshi, Peter Hur, Mark Jones, et al
“Patients were not accurately informed of study purpose, which raises questions regarding the ethics of informed consent in antibiotic trials. Noninferiority and superiority trials entail different benefit-harm trade-offs that must be conveyed for ethical informed consent.”
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Is there a place for CPR and sustained physiological support in brain-dead non-donors?

Journal of Medical Ethics 2017; 43: 679-683.
Author: Stephen D Brown
“The paper first focuses narrowly on requests for CPR and then expands its scope to address extended physiological support. It describes how refusing the brain-dead non-donor’s requests for either CPR or extended support would represent enduring harm to the antemortem or previously autonomous individual by negating their beliefs and self-identity. The paper subsequently discusses potential implications of policy that would allow greater accommodations to those with conscientious objections to currently accepted brain-based death criteria, such as for cost, insurance, higher brain formulations and bedside communication. The conclusion is that granting wider latitude to personal conceptions around the definition of death, rather than forcing a contested definition on those with valid moral and religious objections, would benefit both individuals and society.”
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