Current opinion in anaesthesiology
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An exploration of the ethics, challenges and practical reality of treating family members. Hutchison & McConnell deploy models of virtue, utilitarianism, deontology and principlism in an accessible and applied way.
- Virtue ethics – behaving in the way we think is right; embodying courage.
- Utilitarianism – behaving so as to maximise the best outcomes for the greater number of people.
- Deontology – obeying the rules; following a duty to moral law.
- Principlism – balances beneficence, nonmaleficence, autonomy and justice.
They cautiously challenge the blanket prohibitions of many professional bodies against treating family members.
Well worth reading.
summary“Only by constantly questioning whether they are the correct person to deliver care can they hope to do right by both their relative and themselves.”
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Tattoos and medallions are examples of nonstandard do-not-resuscitate (DNR) orders that some people use to convey end-of-life wishes. These DNR orders are neither universally accepted nor understood for reasons discussed within this manuscript. ⋯ To improve conveyance of an individual's wishes for end-of-life care, the authors discuss nationwide adoption of Oregon's online registry where a person's account could comprehensively document end-of-life wishes, be universally available in all healthcare institutions, and be searchable by common patient identifiers. Facial recognition software could identify unconscious patients who present without identification.
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Curr Opin Anaesthesiol · Apr 2019
ReviewEthical lessons learned and to be learned from mass casualty events by terrorism.
The world has seen a major upturn in international terror awareness. Medicine has had to respond. In addition to the unique physical and mental injuries caused by terror which require special clinical attention, so too terror represents a challenge for medicine from an ethics perspective. ⋯ Although many challenges exist, physicians need to be prepared for ethical response to terror. With their associated unique status, providing legitimacy and specialized ability in the management and approach to terror situations, physicians are held to a higher standard and need to rise to the occasion. This is required in order to promote ethical behavior under trying conditions and ethical sensitivity of the medical profession by means of being attuned to the reality around.
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Curr Opin Anaesthesiol · Apr 2019
ReviewCheaper drugs and techniques to fulfill chief executive officer perspectives - any choices?
Against the background of increasing healthcare costs and diminishing budgets, this review aims to present clinicians with ethically viable options to overcome budgetary restraints when seeking to introduce novel products. ⋯ Health professionals have the responsibility to deliver high-quality care while acknowledging the financial budget constraints. However, evidence (vs. perception) for outcome benefits of novel drugs or devices should stimulate a robust desire for their timely introduction. Demonstrating actual benefits understandable to administrators, seeking alliances with other medical specialties or patient groups, as well as negotiations with the healthcare industry may all represent viable options. Simply waiting for patents to expire should remain a measure of last resort.
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Curr Opin Anaesthesiol · Apr 2019
ReviewIntensivist staffing and outcome in the ICU: daytime, nighttime, 24/7?
Many hospitals, particularly large academic centers, have begun to provide 24-h in-house intensive care attending coverage. Proposed advantages for this model include improved patient care, greater provider, nursing and patient satisfaction, better communication, and greater cost-effectiveness. This review will evaluate current evidence with respect to 24/7 coverage, including patient outcomes, cost-effectiveness, and impact on training/education. ⋯ Although some studies cite increased caregiver and patient satisfaction, outcome studies find no consistent effect on patient-centered outcomes such as mortality or length of stay. Downsides to in-house nighttime attending staffing include physician burnout, adverse effects on physician health, decreased trainee autonomy, and effects on trainee specialty choices because of undesirable lifestyle considerations. Tele-ICU and other novel approaches may allow for attending supervision without physical presence.