Critical care clinics
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Recent discussions about futility have been useful in elucidating health professionals' responsibility to communicate, to establish trust, and to collaborate with patients and families about end-of-life decisions. They have highlighted the often impersonal and fragmented care that patients receive in today's large medical centers. Futility also has been a stalking horse for the much more important and problematic issue of rationing. The latter must be discussed on its own merits, however painful that may be.
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Critical care clinics · Jan 1996
ReviewSpiritual issues and bioethics in the intensive care unit: the role of the chaplain.
This article familiarizes the reader with the contributions of a hospital chaplain regarding spiritual and ethical issues in the intensive care unit. The unique training and perspective of the hospital chaplain are reviewed to explain how the chaplain and the parish minister compare. Cases are presented to illustrate how the chaplain functions, and specific topics of concern that relate bioethical issues with spiritual issues, such as organ donation, are addressed. Faith in "miracles" is discussed within a framework for interpreting religious ideation, particularly when belief prolongs death.
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Critical care clinics · Jan 1996
Case ReportsEthical dilemmas faced by critical care nurses in clinical practice: walking the line.
The experience of the critical care nurse includes frequent ethical dilemmas, both in patient care and in professional relationships. The moral development of the critical care nurse is presented in terms of learning theory, perceptive transformation, and ethical theory as it applies to the predominantly female profession of nursing. Four case studies and verbatim accounts of the experiences of critical care nurses illustrate moral development.
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This article provides a brief review of the history of euthanasia. The problems involved in withholding or withdrawing treatment, physician-assisted suicide, and arguments for or against euthanasia are discussed. Changes in both societal and physician attitudes and practices are presented.
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Critical care clinics · Jan 1996
ReviewNeonatal and pediatric critical care: ethical decision making.
The current standards for surrogate decision making for children are analyzed in this article. A number of potential pitfalls are involved with this issue, including questions about the child's maturity and competence. The present approach for medical decision making for noncompetent children is the "best interest" standard. In many medical decisions, the "best interest" standard is not applicable and a "rational parent" standard is presented.