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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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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Increasing organ donation rates by revealing recipient details to families of potential donors

J Med Ethics, September 2017
Authors: David Shaw, Dale Gardiner
“Many families refuse to consent to donation from their deceased relatives or over-rule the consent given before death by the patient, but giving families more information about the potential recipients of organs could reduce refusal rates. In this paper, we analyse arguments for and against doing so, and conclude that this strategy should be attempted. While it would be impractical and possibly unethical to give details of actual potential recipients, generic, realistic information about the people who could benefit from organs should be provided to families before they make a decision about donation or attempt to over-rule it.”
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Organ Donation: Presumed Consent and Focusing on What Matters

JME Blog, 25 September 2017
Author: Rebecca Brown
“It makes intuitive sense that presumed consent systems would increase organ donation rates, and those who fail to support their introduction often come under criticism. Such criticism tends to assume that failure to support presumed consent is due to a failure to properly recognise the importance of organ donation or a sentimental or squeamish attitude towards bodies as well as oversensitivity towards those who are hesitant about organ donation. Yet, even if one is very concerned with increasing organ donation rates, there are grounds for scepticism about the helpfulness of presumed consent systems as a means of achieving this.”
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Nonvoluntary Psychiatric Treatment Is Distinct From Involuntary Psychiatric Treatment

JAMA. 2017; 318(11): 999-1000.
Author: Dominic A. Sisti
“Some of the most ethically challenging cases in mental health care involve providing treatment to individuals who refuse that treatment. Sometimes when persons with mental illness become unsafe to themselves or others, they must be taken, despite their outward and often vigorous refusal, to an emergency department or psychiatric hospital to receive treatment, such as stabilizing psychotropic medication. On occasion, to provide medical care over objection, a patient must be physically restrained.”
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The ethical basis for performing cardiopulmonary resuscitation only after informed consent in selected patient groups admitted to hospital

Clinical Ethics, 12(3), 111-116
Authors: Philip Berry, Iona Heath
“Cardiopulmonary resuscitation is frequently performed on patients who, in retrospect, had a very low chance of survival. This is because all patients are ‘For cardiopulmonary resuscitation’ on admission to hospital by default, and delays occur before cardiopulmonary resuscitation can be ‘de-prescribed’. This article reviews the nature of potential harms caused by futile cardiopulmonary resuscitation, the reasons why de-prescription may be delayed, recent legal judgements relevant to timely do not attempt cardiopulmonary resuscitation decision making, and the possible detrimental effects of do not attempt cardiopulmonary resuscitation discussions on end of life care.”
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Informed consent and registry-based research – the case of the Danish circumcision registry

BMC Medical Ethics 2017 18:53
Authors: Thomas Ploug, Søren Holm
“Research into personal health data holds great potential not only for improved treatment but also for economic growth. In these years many countries are developing policies aimed at facilitating such research often under the banner of ‘big data’. A central point of debate is whether the secondary use of health data requires informed consent if the data is anonymised.”
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Oral surgeon whose misconduct was “serious, persistent, and shocking” is struck off

BMJ 2017; 358: j4255
Author: Clare Dyer
“A consultant maxillofacial surgeon who harmed patients by carrying out inappropriate surgery—including using an experimental material to rebuild bone—without obtaining informed consent has been struck off the UK medical register.”
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Zika vaccine research: guidance for including pregnant women

Wellcome Trust, 29 June 2017
Source: Wellcome
“Zika infection in pregnancy can have devastating effects on normal fetal development. But pregnant women are often automatically excluded from vaccine trials over safety concerns. New guidance for including pregnant woman and their babies in Zika vaccine research has been published today. The guidelines argue that those most at risk from the virus – pregnant women and their babies – should be at the centre of Zika vaccine development.”
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111 People Ended Their Lives in 6 Months Under California’s New Right-to-Die Law

Fortune, 28 June 2017
Author: Sy Mukherjee
“In 2016, California became the sixth state to enact a “right-to-die” or physician-assisted suicide law (Washington, D.C. also has one in place). Health officials from the Golden State now report that 111 terminally ill patients used the law to legally end their lives in its first six months. 59 people who requested life-ending medication didn’t wind up taking it by the end of 2016 (21 others died without taking the drugs in the first place).”
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