The Journal of clinical ethics
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Medical professionalism has been developing in the Peoples' Republic of China as one way to better address perennial and new challenges in healthcare in an ever-changing society. Among many recent developments in this area is promotion by the national Chinese Medical Doctor Association of the principles and values contained in the international document, "Medical Professionalism in the New Millennium: A Physician Charter." ⋯ Based on responses to the survey, Chinese physicians strongly support the majority of the fundamental principles and responsibilities of medical professionalism, including dedication, altruism, social justice, self-regulation, and informed consent. However, their support for the primacy of patients' welfare as a general principle, and the physician's responsibility to report medical errors and incompetent colleagues, is relatively low. To help advance medical professionalism in the People's Republic of China, professional development programs and medical ethics education should not only emphasize the general principles involved, but also formulate guidelines on how these principles can be carried out in practice.
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Review
The ethical and clinical importance of measuring consciousness in continuously sedated patients.
Continuous sedation at the end of life is a practice that has attracted a great deal of attention. An increasing number of guidelines on the proposed correct performance of the practice have been drafted. All of the guidelines stress the importance of using sedation in proportion to the severity of the patient's symptoms, thus to reduce the patient's consciousness no more than is absolutely necessary. ⋯ Other techniques, such as EEG (electroencephalography) derivatives, may score better on reliability and invasiveness. Yet these have so far never been compared to sedation scale scores for patients receiving continuous sedation at the end of life. Therefore, we conclude that, for both clinical and ethical reasons, research into the efficiency and applicability of other techniques, such as derivatives of EEG, are urgently needed.
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Extracorporeal membrane oxygenation (ECMO) provides continuous circulation and/or oxygenation to adults with cardiac failure, pulmonary dysfunction, or both. The technology is similar to the traditional heart-lung bypass machines used during surgical procedures, however ECMO may be used outside the confines of the operating room and for extended periods of time. ⋯ Symbolically, however, the designation may serve as a stepping-stone for surrogates facing difficult end-of-life decisions. The paper concludes by suggesting that it is prudent to avoid DNR discussions in the context of VA-ECMO
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John H. Evans's views on the multiple roles of healthcare ethics consultants are based on his claim that bioethics is a "distinct profession" that has a "system of abstract knowledge." This response to Professor Evans disputes both of his claims. ⋯ Instead, clinical ethicists rely upon a variety of ethical perspectives and other skills to help resolve conflicts and facilitate healthcare decisions and policy making, whether it is in clinical, research, policy, or organizational contexts. The credibility and effectiveness of clinical ethicists depend upon their knowledge of ethics, their practical experience, and personal abilities, not one form of abstract knowledge.
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This issue's "Legal Briefing" column covers recent legal developments involving total brain failure. Death determined by neurological criteria (DDNC) or "brain death" has been legally established for decades in the United States. But recent conflicts between families and hospitals have created some uncertainty. ⋯ Because of the similarity to medical futility disputes, some court cases on this topic were reviewed in a prior "Legal Briefing" column. But a more systematic review is now warranted. I categorize recent legal developments into the following nine categories: (1) History of Determining Death by Neurological Criteria, (2) Legal Status of Determining Death by Neurological Criteria, (3) Legal Duties to Accommodate Family Objections, (4) Protocols for Determining Death by Neurological Criteria, (5) Court Cases Seeking Physiological Support after DDNC, (6) Court Cases Seeking Damages for Intentionally Premature DDNC, (7) Court Cases Seeking Damages for Negligently Premature DDNC, (8) Court Cases Seeking Damages for Emotional Distress, (9) Pregnancy Limitations on DDNC.