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D L Schiedermayer

Publications and source records attributed to D L Schiedermayer.

At least 19 recordsLinked to original sources
PubMed1991

Ethics consultation: skills, roles, and training.

A clinical ethics consultant gathers information firsthand at the patient's bedside. The consultant's special clinical skills include the ability to identify and analyze ethical problems; use reasonable clinical judgment; communicate effectively; negotiate and facilitate negotiations; and teach others how to construct their own ethical frameworks for medical decision making. Appropriate roles for the consultant include those of professional colleague, negotiator, patient and physician advocate, case manager, and educator. The training necessary for an ethics consultant includes substantial patient care experience, instruction in health care law and moral reasoning, and preparation in medical humanism. We favor a clinical model for ethics consultation. When urgent care is needed, other consultants promptly see the patient; the clinical ethics consultant can be expected to do the same.

Certification↗
PubMed1991

The clinical ethicist at the bedside.

In this paper we attempt to show how the goal of resolving moral problems in a patient's care can best be achieved by working at the bedside. We present and discuss three cases to illustrate the art and science of clinical ethics consultation. The sine qua non of the clinical ethics consultant is that he or she goes to the patient's bedside to obtain specific clinical and ethical information. Unlike ethics committees, which often depend on second hand information from a physician or nurse, clinical ethics consultants personally speak with and examine patients and review their laboratory data and medical records. The skills of the clinical ethics consultant include the ability to delineate and resolve ethical problems in a particular patient's case and to teach other health professionals to build their own frameworks for clinical ethical decision making. When the clinical situation requires it, clinical ethics consultants can and should assist primary physicians with case management.

Adult↗
PubMed1990

Attitudes of internal medicine faculty and residents toward professional interaction with pharmaceutical sales representatives.

We surveyed faculty and residents from seven hospitals affiliated with three academic internal medicine training programs about their perceptions of the informational and service benefits vs the risks of ethical compromise involved in interactions with pharmaceutical sales representatives. Questionnaires were returned by 467 (81%) of 575 physicians surveyed. Residents and faculty generally had somewhat negative attitudes toward the educational and informational value of detailing activities at their institutions but indicated that representatives supported important conferences and speakers. Residents were more likely than faculty to perceive contacts with sales representatives as potentially influencing physician decision making. Sixty-seven percent of faculty and 77% of residents indicated that physicians could be compromised by accepting gifts. More than half of the physicians who suggested that such compromise was possible indicated that acceptance of gifts worth more than +100 from drug companies would be likely to compromise a physician's independence and objectivity. A majority of both faculty and house staff favored eliminating presentations by pharmaceutical representatives at their hospitals. Only 10% thought they had had sufficient training during medical school and residency regarding professional interaction with sales representatives.

Adult↗
PubMed1990

Are adolescents getting smarter about acquired immunodeficiency syndrome? Changes in knowledge and attitude over the past 5 years.

A survey was administered to 1543 adolescents from southeastern Wisconsin to assess their knowledge, attitudes, and beliefs regarding acquired immunodeficiency syndrome (AIDS) and persons with the disease. Responses were compared with those of other studies involving adolescents using identical or similar test items. Results of the study demonstrate that knowledge of AIDS and of the modes of human immunodeficiency virus transmission have increased dramatically over the past 5 years. Ninety-eight percent of high school students in this study understood the modes of transmission and that merely touching a person with AIDS will not transmit the virus. However, results also revealed that many negative biases remain toward people who have been infected with human immunodeficiency virus. Forty-five percent of the students believed that homosexuals and intravenous drug users were "getting what they deserve." Recommendations are made that future educational efforts focus on changes in attitudes and behaviors in relation to adolescents' previously acquired knowledge of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Tears.

Explore the source record for details and available documents.

Crying↗
PubMed1989

Surrogacy and Shakespeare: the Merchant's contract revisited.

Despite measures intended to assure that adequate information, reasonable understanding, and willing participation are involved in surrogacy contracts, questions of economic coercion remain for surrogate mothers. Surrogate contracts have been voided in several states. Nevertheless, obstetricians may be caught between their wish to help the infertile couple desirous of a baby through surrogacy and the ethical and legal questions about the use of surrogacy as a medical treatment. Obstetricians should not be placed in the position of Portia in The Merchant of Venice, that of an arbiter of an unethical contract. Obstetricians should not prescribe or acknowledge surrogacy as a medical treatment and should not knowingly participate in contracts that lead to surrogate pregnancy.

Contracts↗
PubMed1989

One face of beauty, one picture of health: the hidden aesthetic of medical practice.

Unrecognized presuppositions about patient appearance have become increasingly important in medicine, medical ethics and medical law. Symptoms of these historically conditioned assumptions include common ageism, aesthetic surgery, and litigation about 'wrongful life'. These phenomena suggest a societal intolerance for what is considered an 'abnormal' appearance. Among others, eighteenth-century artists and anatomists helped to set these twentieth-century precedents, actually measuring deviations of external traits to analogous deformations of the soul, and drawing moral conclusions from physiognomic measurements. Other eighteenth-century artists countered with pathognomy, recognizing that uneven physical features may indicate humanity, instead of character flaws. We suggest that there is an important and as yet unrecognized role played by visual and perceptual preferences in our judgments concerning normalcy and anomaly. We further suggest a shift away from our current fashion-magazine, youth-oriented aesthetic, and towards an aesthetic of imperfection. Physicians and medical students can be made aware of their historically conditioned reactions to 'abnormal' appearing patients by studying the understandings and methods with which artists have portrayed those who are considered deformed in appearance.

Congenital Abnormalities↗
PubMed1989

Ethics consultations masking economic dilemmas in patient care.

The ethical and economic aspects of treatment decisions are often intimately entwined. We demonstrate how clinical economic questions were raised in clinical ethics consultations involving three patients: a 49-year-old retarded man who required short-term tube feeding; a 74-year-old man with metastatic prostatic cancer whose relatives disagreed about whether or not he should have surgical treatment; and a 55-year-old man whose health maintenance organization declined to pay for liver transplantation. Ethics consultants can help to clarify financial constraints and to resolve financial conflicts of interest. All physicians must develop the ability to unmask economic issues in medical care.

Aged↗