CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
-
Cardiac procedure guidelines often include psychosocial criteria for selecting patients that potentially introduce social value judgements into clinical decisions and decisions about the rationing of care. The aim of this study was to investigate the terms and justifications for and the meanings of psychosocial patient characteristics used in cardiac procedure guidelines. ⋯ Psychosocial characteristics are portrayed as having 2 roles in patient selection: as risk factors intrinsic to the candidate or as indicators of need for special intervention. Guidelines typically simply list psychosocial contraindications without clarifying their specific nature or providing any justification for their use. Psychosocial considerations can help in the evaluation of patients for cardiac procedures, but they become ethically controversial when used to restrict access. The use of psychosocial indications and contraindications could be improved by more precise descriptions of the psychosocial problem at issue, explanations regarding why the criterion matters and justification of the characteristic using a biological rationale or research evidence.
-
Over the last decade there has been a marked increase in case of drug-resistant and severe malaria in Canadian travellers. We report 7 deaths due to falciparum malaria that occurred in Canada or in Canadian travellers. ⋯ Malaria infections and deaths are preventable. Better education of health care providers and travellers about the risks of malaria and appropriate prevention and treatment measures may decrease this unnecessary burden on the Canadian health care system.