Arch Intern Med
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Living wills are considered clear and convincing evidence of a person's preferences for end-of-life treatment. Unfortunately, living wills often use vague language that forces physicians and others to infer specific treatment choices, like the choice to forgo cardiopulmonary resuscitation (CPR). To test the validity of such inferences we examined the relationship between living will completion and CPR preference. We also examined whether CPR choices were fixed or could be influenced by detailed information on CPR. ⋯ Preferences for CPR among subjects with living wills are not homogeneous, but distributed across the clinical scenarios. Therefore, one cannot infer CPR preference from the mere presence of a living will. Cardiopulmonary resuscitation information can influence preferences even among persons with living wills, implying that preferences are neither fixed nor always based on adequate information. Physicians should view vaguely worded documents as unreliable expressions of treatment preference that should not supplant informed discussion.
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Review Practice Guideline Guideline
Ethical considerations in the allocation of organs and other scarce medical resources among patients. Council on Ethical and Judicial Affairs, American Medical Association.
Physicians' efforts on behalf of patients often involve the use of resources that, because of naturally limited supply or economic constraints, are not readily available to all who need them. The dilemma in such cases is how physicians may fulfill their ethical duties to "do all that [they] can for the benefit of the individual patient" when the care that they can provide is constrained by the scarcity of needed resources.
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Before 1987, the hospital survival of patients with acquired immunodeficiency syndrome, Pneumocystis carinii pneumonia, and acute respiratory failure receiving mechanical ventilation was less than 15%. Hospital survival has improved since then, but concerns have been raised that the post-hospital discharge survival of these patients remains extremely poor. This study evaluated the long-term survival of patients discharged alive after an acute episode of acute respiratory failure caused by P carinii pneumonia. ⋯ Post-hospital discharge survival of patients with acquired immunodeficiency syndrome, P carinii pneumonia, and acute respiratory failure has improved dramatically in the past decade. Patients can undergo intubation and mechanical ventilation with the hope of reasonable long-term survival.
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The purpose of the study was to ascertain the prevalence of and reasons for underreporting of occupational exposures to patients' blood and body fluids among students and house staff. ⋯ Although limited by recall bias, this study showed that a high proportion of students and house staff experience occupational exposures. The results suggest that populations at high risk for exposures are the more experienced surgical house staff and the junior medical house staff. Exposures from sources known to be positive or at high risk for human immunodeficiency virus were reported more frequently than those from unknown risk sources.