Journal of medical ethics
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Journal of medical ethics · Sep 2008
Dutch criteria of due care for physician-assisted dying in medical practice: a physician perspective.
The Dutch Euthanasia Act (2002) states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient's suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these criteria in medical practice. ⋯ Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient's subjective perspective(s). However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act.
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Journal of medical ethics · Sep 2008
Decision-making in patients with advanced cancer compared with amyotrophic lateral sclerosis.
Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions. ⋯ Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making.
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Journal of medical ethics · Sep 2008
Clinical research projects at a German medical faculty: follow-up from ethical approval to publication and citation by others.
Only data of published study results are available to the scientific community for further use such as informing future research and synthesis of available evidence. If study results are reported selectively, reporting bias and distortion of summarised estimates of effect or harm of treatments can occur. The publication and citation of results of clinical research conducted in Germany was studied. ⋯ Results of German clinical research projects conducted are largely underreported. Barriers to successful publication need to be identified and appropriate measures taken. Close monitoring of projects until publication and adequate support provided to investigators may help remedy the prevailing underreporting of research.
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The medical response to suicide is generally resuscitation, followed by attempts to maximise the patient's recovery. Care is generally withdrawn when it is futile and there is no hope for recovery. Suicidal patients who have completed an advance directive may complicate matters. Should medical providers not resuscitate a patient with an advance directive who has attempted to commit suicide? If stated wishes for care are ignored in the emergency setting, how should decisions be made over time in the event of a successful resuscitation resulting in the need for prolonged therapy counter to the wishes of the advance directive? What are the merits of the stated the wishes of suicidal patient? What if they were depressed at the time of the advance directive? This case highlights the need for consideration of these and other concerns in the care of patients who commit suicide and have an advance directive.
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Despite much research on informed choice and the individuals' autonomy in organised medical screening, little is known about the individuals' decision-making process as expressed in their own words. ⋯ In a welfare state where governmental institutions are trusted, mass screening for disease is acknowledged by screening participants as a valued expression of paternalism. Trust, gratitude, and convenience were more important factors than information about benefits, harms, and risks when the women made their decisions to attend screening. These elements should be included in the ethical debates on informed choice in preventive medicine.