Emergency medicine clinics of North America
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Disasters are defined medically as mass casualty incidents in which the number of patients presenting during a given time period exceeds the capacity of the responders to render effective care in a timely manner. During such circumstances, triage is instituted to allocate scarce medical resources. ⋯ Specific questions include whether resources truly are limited, whether specific numbers should dictate disaster response, and whether triage decisions should be based on age or social worth. The primary question the authors pose is whether disaster triage, as currently advocated and practiced in the western world, is actually ethical.
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Decision making near the end of life can be complex and laden with emotion for families and health care providers. Families and patients can prepare themselves for these difficult moments by thinking ahead about the patient's wishes and preparing clear documents that express those wishes. Health care providers can prepare themselves by being familiar with those documents, considering the goals of treatment, remembering the principles on which health care ethics are founded and knowing decision-making models that will help them to think through treatment plans and the best options for patient taking into consideration the goals of treatment.
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Emerg. Med. Clin. North Am. · Aug 2006
ReviewConflict of interest in the physician interface with the biomedical industry.
The physician interface with the pharmaceutical industry stands at the forefront of a debate about the effect this relationship has on the behavior of both researchers and clinicians. The authors explore the basis for this conflict of interest and show how it affects physician judgment and behavior. These effects lead to negative consequences for patients and threaten the professional status that society accords physicians. In view of the potential for ethical compromise, physicians should refrain from contact with pharmaceutical marketing representatives.
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Emerg. Med. Clin. North Am. · Aug 2006
ReviewEthical dilemmas in the care of minors in the emergency department.
Minors may give consent for their own medical care in several situations: as emancipated minors, when they present with conditions covered by minor treatment statutes, and when they are designated as "mature" minors. Definitions vary from state to state. ⋯ A psychosocial assessment should be performed as part of the emergency department evaluation of most adolescent minors. The emergency physician should help facilitate the involvement of a parent or other support person in the health issues of adolescent minors whenever possible, especially with younger adolescents.
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Emerg. Med. Clin. North Am. · Aug 2006
ReviewInformed consent and refusal of treatment: challenges for emergency physicians.
Due to the distinctive features of the hospital emergency department and its patients, emergency physicians confront special challenges in respecting patient rights to informed consent to treatment. After a brief review of the doctrine of informed consent and of its significance in the emergency department, this article will examine three specific challenges for informed consent and refusal of treatment in emergency medicine: (1) assessing patient decision-making capacity, (2) performing procedures on the newly dead, and (3) making treatment decisions for patients in legal custody.