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Biomedical subjects

B A Rich

Publications and source records attributed to B A Rich.

12 recordsLinked to original sources
PubMed2001

Defining and delineating a duty to prognosticate.

Prognostication, the process of formulating and communicating a prognosis, is no longer considered by most physicians to be an essential task in caring for patients with serious illness. Because of this fact, it is not surprising to find that when physicians attempt to engage in prognostication, they do it poorly. What may be surprising to those outside the medical community is the extent to which professional norms have developed which actively discourage physicians from engaging in prognostication. This article explores the causes of this state of affairs and the justifications offered for it. The conclusion is reached that physicians have a professional responsibility to competently engage in prognostication based upon the doctrine of informed consent, and that a failure or refusal to do so has not only potential legal ramifications, but serious negative implications for many of the core issues in bioethics, such as the use of advance directives, palliative medicine, and medical futility.

Attitude of Health Personnel↗
PubMed1999

A historical perspective of informed consent in clinical practice and research.

OBJECTIVES: To review the historical perspective of informed consent in clinical practice and research as it pertains to human subjects. DATA SOURCES: Published professional journals, books, case law, and the internet pertaining to the historical development of informed consent. CONCLUSIONS: The history of informed consent is complex. Informed consent as a fundamental principle of clinical ethics has developed within the past 50 years. Full disclosure and shared decision making have not come naturally to clinicians. Consequently, respecting the autonomy of patients and research subjects requires a conscious, sustained effort by clinicians. IMPLICATIONS FOR NURSING PRACTICE: Knowledge of the history of informed consent is important for practicing cancer nurses to ensure they understand the significance of preserving patient autonomy and advocate for the patient and research subject.

Clinical Trials as Topic↗
PubMed1998

Personhood, patienthood, and clinical practice: reassessing advance directives.

This article considers 2 major critiques of advance directives and offers a defense to each of them. The 1st critique is philosophical in nature and maintains that the moral authority of an advance directive is undercut by a failure of personal identity to survive the loss of decisional capacity. The response in this article is that this critique relies on a flawed and disfavored concept of persons and their persistence over time. The 2nd critique, pragmatic in nature, argues that advance directives cannot be authoritative because the requisite elements of an informed consent to or refusal of treatment are rarely present, and many such instruments are ambiguous. The author argues that if the creation of advance directives, as a form of advance care planning, is made an integral aspect of clinical practice, many more patients will elect to execute directives, and those directives will not be ambiguous.

Advance Care Planning↗