Roles and responsibilities of clinical ethics committees in priority setting

BMC Medical Ethics, 2017 18:68
Authors: Morten Magelssen, Ingrid Miljeteig, Reidar Pedersen, Reidun Førde
“Fair prioritization of healthcare resources has been on the agenda for decades, but resource allocation dilemmas in clinical practice remain challenging. Can clinical ethics committees (CECs) be of help? The aim of the study was to explore whether and how CECs handle priority setting dilemmas and contribute to raising awareness of fairness concerns.”
Find article here.

What to Do When a Patient Has a ‘Do Not Resuscitate’ Tattoo

The Atlantic, 1 December 2017
Author: Ed Yong
In Florida, patients can ask not to be resuscitated by filling in an official form and printing it on yellow paper. (Yes, it has to be yellow.) Only then is it legally valid. Clearly, a tattoo doesn’t count. And yet, the patient had clearly gone through unusual effort to make his wishes known. The team members debated what to do, and while opinions differed, “we were all unanimous in our confusion,” says Holt.
Find article here.

The strange case of Mr. H. Starting dialysis at 90 years of age: clinical choices impact on ethical decisions

BMC Medical Ethics 2017 18:61
Authors: Giorgina Barbara Piccoli, Andreea Corina Sofronie, Jean-Philippe Coindre
“Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at “extreme” ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions.”
Find article here.

Health Care Complaints Commission v Kesserwani [2017] NSWCATOD 149

Decision date: 23 October 2017
“Chiropractor – professional boundaries – communication with patient after complaint made – complaint withdrawn by patient – false statements made to the Health Care Complaints Commission about extent of contact with patient. Improper and unethical conduct. Whether conduct amounted to professional misconduct.”
Find decision here.

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.”
Find article here.

Medics as force multipliers around Mosul—at the expense of medical ethics?

The BMJ Opinion, 14 June 2017
Author: Jonathan Whittall
“But there is also a vital role for independent civilian health providers, such as MSF, to operate in accordance with the basic principles of impartiality and medical ethics. Independent health facilities allow patients who do not feel safe going to military installations to still access care, whereas the marriage between medicine and the military limits the safe options available to patients. If healthcare is only carried out as a component of the overall military strategy, it undermines the very basis of medical ethics.”
Find article here.

Offending in theatre: the case of Ian Paterson

BMJ 2017; 357: j2583
Author: Gwen Adshead
“This highly trained and experienced doctor seems to have deliberately conned people into having surgery that they did not need, and in doing so convinced them that they were seriously ill and he was saving their lives. The question has been raised as to what his motivation could be.”
Find article here.

Ethical issues in dialysis therapy

The Lancet, Volume 389, No. 10081, p1851–1856, 2017
Authors: Vivekanand Jha, Dominique E Martin et al
“Treatment for end-stage kidney disease is a major economic challenge and a public health concern worldwide. Renal-replacement therapy poses several practical and ethical dilemmas of global relevance for patients, clinicians, and policy makers. These include how to: promote patients’ best interests; increase access to dialysis while maintaining procedural and distributive justice; minimise the influence of financial incentives and competing interests; ensure quality of care in service delivery and access to non-dialytic supportive care when needed; minimise the financial burden on patients and health-care system; and protect the interests of vulnerable groups during crisis situations. These issues have received comparatively little attention, and there is scant ethical analysis and guidance available to decision makers.”
Find article here.

On classifying the field of medical ethics

BMC Medical Ethics 2017 18:30
Authors: Kristine Bærøe, Jonathan Ives, Martine de Vries, Jan Schildmann
“In 2014, the editorial board of BMC Medical Ethics came together to devise sections for the journal that would (a) give structure to the journal (b) help ensure that authors’ research is matched to the most appropriate editors and (c) help readers to find the research most relevant to them. The editorial board decided to take a practical approach to devising sections that dealt with the challenges of content management. After that, we started thinking more theoretically about how one could go about classifying the field of medical ethics. This editorial elaborates and reflects on the practical approach that we took at the journal, then considers an alternative theoretically derived approach, and reflects on the possibilities, challenges and value of classifying the field more broadly.”
Find article here.

NHMRC releases updated assisted reproductive technology guidelines

NHMRC, 20 April 2017
“The National Health and Medical Research Council (NHMRC) today released the Ethical guidelines on the use of assisted reproductive technology in clinical practice and research, 2017 (ART guidelines). This update replaces the 2007 ART guidelines and provides contemporary ethical guidance for the conduct of ART in the clinical setting. The ART guidelines articulate ethical principles and, when read in conjunction with federal and state or territory legislation, create a robust framework for the conduct of ART in Australia.”
Find media release and guideline here.