Aid-in-Dying Laws and the Physician’s Duty to Inform

JME Blog, 22 March 2017
Author: Mara Buchbinder
“Why do so many people assume that any clinical communication about aid-in-dying (AID, also known as assisted suicide), where it is legal, ought to be patient-initiated? Physician participants in my ongoing study tend to assume that physicians should wait for patients to initiate discussions of AID. The clinical ethics literature on communication about AID has reinforced this expectation by focusing on how to respond to patient requests. Consequently, bioethics has largely remained silent on whether there is a professional duty to inform terminally ill patients about AID laws and their clinical and legal requirements.”
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Doctors Consider Ethics Of Costly Heart Surgery For People Addicted To Opioids

NPR, 21 March 2017
Author: Jack Rodolico
“Milford is part of a group of opioid addicts whom doctors describe as the sickest of the sick: intravenous drug users, mostly people who use heroin, who get endocarditis. Some aspects of their treatment present an ethical dilemma for doctors. Cardiologists, surgeons and infectious disease doctors can fix the infection, but not the underlying problem of addiction.”
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Presumed consent: licenses and limits inferred from the case of geriatric hip fractures

BMC Medical Ethics 2017 18:17
Authors: Joseph Bernstein, Drake LeBrun, Duncan MacCourt, Jaimo Ahn
“Hip fractures are common and serious injuries in the geriatric population. Obtaining informed consent for surgery in geriatric patients can be difficult due to the high prevalence of comorbid cognitive impairment. Given that virtually all patients with hip fractures eventually undergo surgery, and given that delays in surgery are associated with increased mortality, we argue that there are select instances in which it may be ethically permissible, and indeed clinically preferable, to initiate surgical treatment in cognitively impaired patients under the doctrine of presumed consent.”
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Response to ‘A matter of life and death: controversy at the interface between clinical and legal decision-making in prolonged disorders of consciousness’

BMJ Blogs, 3 March 2017
Author: Julian Sheather
“The law has to work in generalities. The prohibitions it imposes and the liberties it describes are set for all of us, or for large classes of us. But we live – like we sicken and die – as individuals. Lynne Turner-Stokes gives a vivid account of an area of clinical practice where these truisms come into conflict. Practice Direction 9E (PD9E) doesn’t sound like much, a piece of dry-as-dust procedure for the Court of Protection, but it governs an area of keen moral concern: for our purposes, decisions relating to the withdrawing or withholding of clinically-assisted nutrition and hydration (CANH) from patients in a persistent vegetative state (PVS) or a minimally conscious state (MCS). According to PD9E, all such decisions should be bought before the Court of Protection.”
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Variation in the costs of surgery: seeking value

Med J Aust 2017; 206 (4): 153-154.
Authors: David J Hillis, David AK Watters, et al
“To ensure high value, the procedures performed must be appropriately indicated, avoiding overservicing or selecting a particular treatment when its likelihood of success, compared with the alternatives, is limited. Health professionals have an ethical responsibility to avoid waste in health care — not only by better targeting resources, but also because “useless tests and treatments cause harm”.
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The doctor’s dilemma: is it ever good to do harm?

The Guardian, 9 February 2017
Author: Gwen Adhsead
“Medical knowledge changes swiftly, and technological changes make new and expensive investigations and treatments possible that were only theoretical a few years ago. Life has been extended in length, but not in quality, and the debates about end?of?life decisions show us how much the notion of a “good life” is bound up with the absence of disease, illness and suffering.”
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Clinical ethics issues in HIV care in Canada: an institutional ethnographic study

BMC Medical Ethics 2017 18:9
Authors: Chris Kaposy, Nicole R. Greenspan, Zack Marshall, Jill Allison, Shelley Marshall, Cynthia Kitson
“We found that health care providers and clinic clients have developed work processes for managing ethical issues of various types: conflicts between client-autonomy and public health priorities (“treatment as prevention”), difficulties associated with the criminalization of nondisclosure of HIV positive status, challenges with non-adherence to HIV treatment, the protection of confidentiality, barriers to treatment access, and negative social determinants of health and well-being.”
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Ethical framework for the detection, management and communication of incidental findings in imaging studies, building on an interview study of researchers’ practices and perspectives

BMC Medical Ethics 2017 18:10
Authors: Eline M. Bunnik, Lisa van Bodegom, Wim Pinxten, Inez D. de Beaufort, Meike W. Vernooij
“As thousands of healthy research participants are being included in small and large imaging studies, it is essential that dilemmas raised by the detection of incidental findings are adequately handled. Current ethical guidance indicates that pathways for dealing with incidental findings should be in place, but does not specify what such pathways should look like.”
Find article here.