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Biomedical subjects

Denise M Dudzinski

Publications and source records attributed to Denise M Dudzinski.

14 recordsLinked to original sources
PubMed2006

Ethics guidelines for destination therapy.

The introduction of the left ventricular assist device as a destination therapy for patients with heart failure introduces several ethical issues. These issues are discussed to help destination therapy teams design ethically sound policies and procedures. This article addresses ethical issues pertaining to informed decision making, device failure, and change out, as well as guidelines for deactivation, fair employment of medical and psychosocial criteria, the nature of destination therapy as an elective end-of-life therapy, and advance care planning strategies.

Decision Trees↗
PubMed2006

Competent patients' refusal of nursing care.

Competent patients' refusals of nursing care do not yet have the legal or ethical standing of refusals of life-sustaining medical therapies such as mechanical ventilation or blood products. The case of a woman who refused turning and incontinence management owing to pain prompted us to examine these situations. We noted several special features: lack of paradigm cases, social taboo around unmanaged incontinence, the distinction between ordinary versus extraordinary care, and the moral distress experienced by nurses. We examined this case on the merits and limitations of five well-known ethical positions: pure autonomy, conscientious objection, paternalism, communitarianism, and feminism. We found each lacking and argue for a 'negotiated reliance' response where nurses and others tread as lightly as possible on the patient's autonomy while negotiating a compromise, but are obligated to match the patient's sacrifice by extending themselves beyond their usual professional practice.

Ethical Analysis↗
PubMed2004

Ethical issues in fertility preservation for adolescent cancer survivors: oocyte and ovarian tissue cryopreservation.

UNLABELLED: Oocyte and ovarian tissue harvesting and implantation may one day restore fertility in adolescent cancer survivors. Discussion ensues regarding ways to respect patients and address ethical issues in future clinical trials. STUDY OBJECTIVE: To offer a normative analysis of ethical issues in oocyte and ovarian tissue cryopreservation and implantation for adolescent cancer survivors. DESIGN: Normative ethical analysis. RESULTS AND CONCLUSION: Oocyte and ovarian tissue harvesting and implantation hold promise in restoring fertility in adolescent cancer survivors; however, more research is required before adolescents can ethically be enrolled in clinical trials. As these methods advance, clinician investigators serve these patients best by (1). ensuring that the intervention does not harm the patient by delaying cancer treatment; (2). ensuring that no remnant cancer cells will be reintroduced in transplantation or fertilization; (3). preventing damaged cryopreserved oocytes from being fertilized and implanted; (4). seeking informed assent from adolescent patients and informed consent from their parents or guardians; (5). developing policies to protect the patient's future rights to her gametes; (6). developing policies addressing the disposition of gametes if the patient dies; and (7). respecting the patient by protecting her from harm while also honoring her right to self-determination.

Adolescent↗
PubMedDate not supplied

When agreeing with the patient is not enough: a schizophrenic woman requests pregnancy termination.

In this article, we discuss the ethical dilemma health care providers faced when Rebecca, a pregnant schizophrenic patient who lacked decision-making capacity, inconsistently requested elective pregnancy termination. When a patient's decision-making capacity is severely impaired, how does the physician balance obligations to protect the patient from harm (beneficence) while also respecting her reproductive preferences and decisions (respect for autonomy)? Rebecca suffers from polysubstance abuse and paranoid schizophrenia characterized by disorganized thought and speech, auditory hallucinations, and delusional ideas. She arrived 14+ weeks pregnant and unaccompanied at an obstetric clinic requesting an abortion. This is her second and final request. On all prior and subsequent occasions, she was either ambivalent or said she wanted to continue the pregnancy. After the consulting psychiatrist determined that she lacked decision-making capacity, steps were taken to address ethical and clinical issues. The steps included treating her schizophrenia to see if she could regain decision-making capacity; identifying a surrogate and using a shared decision-making model; and devising strategies to protect Rebecca and her fetus without resorting to excessive paternalism. Rebecca continued her pregnancy. Due to poor adherence to medical regimen and inadequate social support, Rebecca's schizophrenia was poorly controlled and she continued to use drugs during the pregnancy. She delivered a term baby who was soon removed from her custody. Despite some people's desire to protect Rebecca by complying with her request for abortion, we conclude that to do so would be ethically unjustified. To treat a decisionally impaired patient's requests for abortion as autonomous is disrespectful of the vulnerable patient because such paternalism fails to respect the patient's liberty and the surrogate's authority.

Abortion Applicants↗
PubMedDate not supplied

Compounding vulnerability: pregnancy and schizophrenia.

The predominant ethical framework for addressing reproductive decisions in the maternal-fetal relationship is respect for the woman's autonomy. However, when a pregnant schizophrenic woman lacks such autonomy, healthcare providers try to both protect her and respect her preferences. By delineating etic (objective) and emic (subjective) perspectives on vulnerability, I argue that options which balance both perspectives are preferable and that acting on etic perspectives to the exclusion of emic considerations is rarely justified. In negotiating perspectives, we balance the etic commitment to protect the vulnerable patient and her fetus from harm with the emic concern to empower a decisionally incapacitated woman. Equilibrium is best achieved by nurturing interdependent relationships that empower and protect the vulnerable woman. The analysis points to the need for better social support for mentally ill patients.

Abortion Applicants↗