Thoracic surgery clinics
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HIPAA regulations have been seen by many physicians as providing innumerable administrative hoops that require jumping through with no clear benefit for individual patients. Although this article has not comprehensively explored the requirements of HIPAA regulations, it has focused on the issues of "incidental disclosures" that are so important to the daily interactions of physicians and patients. Through the use of illustrative cases, it has been shown that HIPAA regulations frequently are based on well-accepted ethical principles. ⋯ As Lo and colleagues have very appropriately pointed out: In the context of inadvertent disclosure, the legal risks of good practice are very low. Physicians should work with risk managers and practice administrators to develop policies that promote good communication in patient care, while taking appropriate steps to protect patient privacy. By adopting such an approach to HIPAA, physicians can abide by the regulations while maintaining high ethical standards and minimizing the impact of the new requirements on physician-patient relationships.
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Informed consent plays a major role in forming a therapeutic alliance with the patient. The informed consent process has evolved from simple consent, in which the surgeon needed only to obtain the patient's permission for a procedure, into informed consent, in which the surgeon provides the patient with information about clinically salient features of a procedure, the patient understands this information adequately, and the patient voluntarily authorizes the surgeon to perform the procedure. Special circumstances of informed consent include conflicting professional opinions, consent with multiple physicians, patients who are undecided or refuse surgery, patients with diminished decision-making capacity, surrogate decision making, pediatric assent, and consent for the involvement of trainees.
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Thoracic surgery clinics · Nov 2005
ReviewWithdrawing life-sustaining treatment: ethical considerations.
In the community of caregivers, there is a general consensus that some heroic measures are not obligatory in certain circumstances that are defined by professional norms. For example, cardiopulmonary resuscitation in terminal cancer patients is not endorsed because of its violation of the dignity of the irremediably ill, and its unproductive cost to society. Moving back from this extreme, the availability and effectiveness of life-prolonging treatments, such as ventilators, dialysis, and implantable mechanical hearts, moves into a domain where the boundary limit of the obligation to preserve life is less clearly defined. ⋯ Neglecting this part of the duty to provide appropriate care brings moral anguish to all participants in the peculiar circumstances that have come to surround death in the ICUs of developed countries. It is helpful to accept the inevitable reality that death is, in Shakespeare's words, a "necessary end" to all mortal life, and to recognize that defying death with technology can sometimes become an unnatural and degrading activity, however well motivated. The withdrawal of life-sustaining treatment, when conducted expertly, is a shared human experience that can be gratifying, although difficult for all concerned.
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Thoracic surgery clinics · Nov 2005
ReviewPostoperative futile care: stopping the train when the family says "keep going".
All surgeons must take risks when providing medical care. No guarantees of protection from a lawsuit exist in any guise. Concerning postoperative futile care, the stakes are high when withdrawal of support seems to be indicated but the surrogate believes in sanctity-of-life and demands continued aggressive care. ⋯ If so, "do what's right" is not just to "stop the train." It also consists of a range of clinical activities, including effective communication, emotional care, and pursuing a fair and open negotiation process established by the institution. Properly conducted, "stopping the train" should incur no greater risk for professional liability than any other challenging procedure that surgeons perform. Withdrawal of futile care should be considered as a procedure, and as such, the skills to deliver it should be mastered like any other.
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Higher standards of evidence for surgical procedures are likely to be demanded in the future by health insurance providers. Consequently, more formal and rigorous surgical research, including RCTs, will become more prevalent. Facing the ethical challenges of surgical research requires understanding of the ethically significant differences between surgical practice and research and the ways in which the ethical standards appropriate for the design and conduct of clinical research differ from the ethics of clinical care.