Critical care clinics
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Critical care clinics · Jan 1996
ReviewEthical issues in organ procurement: a review for intensivists.
The current state of organ procurement and the ethical issues raised by the procurement process are reviewed in this article. After an examination of the legislative framework governing organ procurement, the intensivist's role in donation is discussed, including (1) donor identification, (2) asking the family to donate, and (3) obtaining consent. Recent proposals for changing the organ procurement system are analyzed, including increasing family donation or increasing the donor pool.
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This article comprehensively addresses the composition, role, and functions of a hospital ethics committee (HEC). HECs are of particular interest to critical care specialists because they often participate in or lead such committees, extending their commitment to communication and caring beyond the borders of the intensive care unit (ICU). This article also demonstrates that a well-run ICU in a hospital with a strong HEC automatically will include many of the services that the HEC normally would provide, without the need for HEC assistance.
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For historical reasons, much of the attention to the doctor-patient relationship has been based on the concept of informed consent. The concepts of information and consent are both problematic, and as a result, consent forms and advanced directives often undermine the goal that led to the consent doctrine. A better ethic can be derived from stressing the connection between doctor and patient and determining how that connection can be fostered.
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Critical care clinics · Jan 1996
ReviewThe language of death: euthanatos et mors--the science of uncertainty.
This article proposes that the medical community has a responsibility to guide and to treat patients through death just as it guides and treats them through life. A number of misunderstood concepts relating to this responsibility are discussed. An approach to the management of death that requires an embracing of medical uncertainty is developed.
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The universal presumption of consent for cardiopulmonary resuscitation creates several practical and ethical dilemmas and should be challenged. Ethically based decision making demands a reality-based dialogue about resuscitation with patients and the community at large.