Browsing by Subject "Medical ethics"
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Item Conscience in the Mental Health Professional(1997) Galvin, Matthew R.; Stilwell, Barbara M.Item Conscientious objection in the healing professions: a readers' guide to the ethical and social issues(One Health: Information in an Interdependent World. Medical Library Association Annual Meeting and Exhibition; 2013 May 6-8; Boston, MA. http://www.mlanet.org/am/am2013/, 2013-05-07) Odell, Jere D.; Comer, Amber (Malcolm); Rua, Avril N.; Abhyankar, RahulWhat is a health care provider to do when they find that their moral integrity is at odds with professional expectations? Should a nurse with religious objections to assisted reproduction be asked to stop working in obstetrics and gynecology? Can a pharmacist with moral objections to emergency contraception refer a patient to a colleague without being complicit in a perceived moral wrong doing? Should religious organizations be required to provide or pay for objectionable health services? When is a patient's health and well-being more important than a professional's moral integrity? Here we: 1) describe a collaboration between a medical librarian and the Indiana University (IU) Conscience Project 2) outline the subject of conscientious objection in the healing professions, and 3) introduce a new readers' guide on the topic.Item The effect of a state health care consent law on patient care in hospitals: A survey of physicians(Sciedu Press, 2018-03-05) Comer, Amber R.; Gaffney, Margaret; Stone, Cynthia; Torke, Alexia; Physical Therapy, School of Health and Human SciencesObjective: When a patient cannot make medical decisions for him or herself, and has not appointed a healthcare representative, default state healthcare consent laws determine who is able to make healthcare decisions for the patient. The narrow construction of some state laws leaves many patients in situations where the closest person to the patient does not qualify as a representative under the law, or where the patient has too many representatives and a consensus cannot be reached on the patient’s medical care. Methods: In order to determine how state healthcare consent laws affect patient care in hospitals, a survey of 412 Indiana physicians was conducted. Results: The data shows 53.8% of physicians experienced a delay in patient care because they were unable to identify a legally appropriate health care representative. Almost half (46.01%) of physicians experienced delay of patient care due to the inability to identify a final decision maker when disputes arose between multiple legal representatives. Conclusions: The results of this study have important implications for hospital administrators as a delay in patient care can be costly and unnecessarily utilizes hospital resources. Additionally, the results of this study have important implications for the status of state surrogate decision making laws. Amending state laws to include more potential surrogates, has the potential to minimize delays in patient care and ensure that appropriate surrogates are making medical care decisions for patients without the undue burden of court intervention.Item Giving patients granular control of personal health information: Using an ethics “Points to Consider” to inform informatics system designers(http://dx.doi.org/10.1016/j.ijmedinf.2013.08.010, 2013-12) Meslin, Eric M.; Alpert, Sheri A.; Carroll, Aaron E.; Odell, Jere D.; Tierney, William M.; Schwartz, Peter H.OBJECTIVE: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. METHODS: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a "Points to Consider" (P2C) document, and convened a national expert panel to review and critique the P2C. RESULTS: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions ("Points") that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. DISCUSSION: The P2C is intended to clarify what is at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion.Item Implementing best practices: Converting good ethics into good law(2008-07-23T20:50:43Z) Orentlicher, DavidItem The legal and ethical implications of the Indiana surrogate decision making impact on physicians and patient care in Indiana hospitals(2015) Comer, Amber R.; Silverman, Ross David; Torke, Alexia Mary; Eberl, Jason; Gaffney, Margaret M.; Stone, Cynthia L.Background: When a patient is incapacitated and unable to make health care decisions, a surrogate decision maker must be designated to make decisions about the patient’s care in his or her place. Studies show that fewer than 20% of patients in hospitals present with a designated health care representative form. Therefore, the overwhelming majority of surrogates in hospitals are identified via default state statutes. Little is known about the implications of state default surrogate decision making statutes on physicians and patient care in clinical practice. Methods: An evaluation of state surrogate decision making statutes was conducted in order to determine variability among state laws. Additionally, a statewide, quantitative, descriptive, cross-sectional survey of a random sample of 405 physicians working in Indiana hospitals was conducted to determine: 1) physicians’ knowledge of Indiana’s surrogate decision making law; 2) physicians’ approaches to hypothetical cases they might encounter in hospital practice; and 3) any delay in patient care physicians experience as a result of state surrogate decision making laws. Results: There is very little consistency among states regarding who may serve as a surrogate decision maker. In Indiana, less than half of the surveyed physicians (47.90%) were able to correctly identify legally allowable surrogates. When presented with clinica vignettes, nearly all physicians (84.90%) report that they would allow a grandchild to act as a surrogate decision maker, even though grandchildren are not legal surrogates under the law. Additionally, more than half of physicians (53.8%) experienced a delay in patient care due to the inability to identify a legal surrogate. Conclusions: The narrow construction of state laws can leave patients in situations where they either have no qualified surrogate under the law or where they have multiple surrogates. If there are multiple surrogates with competing interests a consensus may not be reached on the patient’s medical care. These situations result in a delay of patient care. The results of this study show that the Indiana Surrogate Decision Making law is flawed as it does not reflect the composition of Indiana families and leads to delays in patient care.Item Medical Ethics in Nephrology: A Jewish Perspective(Rambam Health Care Campus, 2016-04-19) Friedman, Allon N.; Department of Medicine, IU School of MedicineJewish medical ethics is arguably the oldest recorded system of bioethics still in use. It should be of interest to practicing nephrologists because of its influence on the ethical systems of Christianity, Islam, and Western secular society; because of the extensive written documentation of rabbinical response in addressing a broad range of bioethical dilemmas; and in understanding the values of patients who choose to adhere to religious Jewish law. The goal of this review is to provide a brief overview of the basic principles underlying mainstream traditional Jewish medical ethics, apply them to common clinical scenarios experienced in nephrology practice, and contrast them with that of secular medical ethics.Item New approaches to research with vulnerable populations - interdisciplinary application of a framework for vulnerability and adolescent capacity to consent(2015-10-16) McGregor, Kyle A.; Hall, James A.; Bennett, Larry W.; Wilkerson, David A.; Ott, Mary A.Children's and adolescents' capacity to provide valid informed consent is one of the key ethical concerns in pediatric research, and the focus of this project. The original contribution to knowledge is the advancement of both conceptual and empirical bioethical approaches to research with vulnerable populations. First, a review of adolescent vulnerability is presented to highlight the complex interplay between capacity and other forms of vulnerability. This review is offered as an interdisciplinary analysis to better understand why the study of vulnerable populations is critical to the ethical advancement of clinical research. Results from this analysis suggest the need for enhanced screening techniques as well as the utilization of specialized staff to identify and reduce the impact of different forms of vulnerability. The primary tasks of the empirical portion of the dissertation were to: (1) Adapt a validated adult competency assessment tool for clinical research, the MacArthur Competency Assessment Tool for Clinical Research, to assess the capacity of children and adolescents to consent to clinical research; (2) Identify predictors that impact children and adolescents’ capacity to provide consent to clinical research; and (3) assess differences and similarities in capacity between healthy and chronically ill children and adolescents. Overall results suggest adolescent capacity to consent to research was similar to adults, and most strongly associated with their family's socioeconomic status as well as their level of health literacy. These findings contrast starkly with the age-based criterion for providing consent currently utilized in assent and consent determinations. These findings also provide insights into ways to ethically involve youth in complex biomedical research.Item Performance of crisis standards of care guidelines in a cohort of critically ill COVID-19 patients in the United States(Elsevier, 2021) Jezmir, Julia L.; Bharadwaj, Maheetha; Chaitoff, Alexander; Diephuis, Bradford; Crowley, Conor P.; Kishore, Sandeep P.; Goralnick, Eric; Merriam, Louis T.; Milliken, Aimee; Rhee, Chanu; Sadovnikoff, Nicholas; Shah, Sejal B.; Gupta, Shruti; Leaf, David E.; Feldman, William B.; Kim, Edy Y.; STOP-COVID Investigators; Graduate Medical Education, School of MedicineMany US states published crisis standards of care (CSC) guidelines for allocating scarce critical care resources during the COVID-19 pandemic. However, the performance of these guidelines in maximizing their population benefit has not been well tested. In 2,272 adults with COVID-19 requiring mechanical ventilation drawn from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID) multicenter cohort, we test the following three approaches to CSC algorithms: Sequential Organ Failure Assessment (SOFA) scores grouped into ranges, SOFA score ranges plus comorbidities, and a hypothetical approach using raw SOFA scores not grouped into ranges. We find that area under receiver operating characteristic (AUROC) curves for all three algorithms demonstrate only modest discrimination for 28-day mortality. Adding comorbidity scoring modestly improves algorithm performance over SOFA scores alone. The algorithm incorporating comorbidities has modestly worse predictive performance for Black compared to white patients. CSC algorithms should be empirically examined to refine approaches to the allocation of scarce resources during pandemics and to avoid potential exacerbation of racial inequities.