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Biomedical subjects

F H Marsh

Publications and source records attributed to F H Marsh.

17 recordsLinked to original sources
PubMed1992

Why physicians should not do ethics consults.

Increasing complexities facing physicians negotiating the bedside decision continue to fuel the debate over who is the appropriate party to offer ethics consults, should one be needed, during the decision-making process. Some very good arguments have been put forth on behalf of clinical ethicists as being the proper and best party to engage in ethics consultations. However, serious questions remain about the role of the clinical ethicist and his ability to provide the necessary level of objectivity called for in an ethics consult. I argue that the clinician's professional psyche, or mode of thinking as a professional, leaves him little room to maneuver as an objective and detached third party ethics consultant. Several factors are cited and discussed that greatly influence the analyses applied to a case problem by physicians. The most formidable of these factors are habits and the practice of defensive medicine. I conclude that clinical ethicists are less suited for the overall tasks required of an objective consultant in medical cases that appear to involve insurmountable ethical issues.

Decision Making↗
PubMed1987

Psychosis and pregnancy: some new ethical and legal dilemmas for the physician.

Physicians who treat women of childbearing age may encounter the presentation of psychosis in a pregnant woman that presents special problems in diagnosis and treatment, particularly ethical and legal considerations that center on the rights of the mother as well as the continually evolving definition of fetal rights. This article represents a collaborative effort to address these considerations. Representative case material from the treatment of a psychotic pregnant patient is presented with a focus on the nature of the contractual relationship of the treating physician with the mother and fetus.

Ethics, Medical↗
PubMed1986

Informed consent and the elderly patient.

Achieving a moral informed consent from a patient is certainly no easy task for the physician. Patient autonomy has become a watchword of the medical profession and has promoted to some extent an emphasis on the idea of noninterference with the patient as the essential feature of the physician's respect for this autonomy. This is unfortunate because noninterference in many instances really does not take into account the transforming effects of illness and their impact on informed consent. In illness, the body is interposed between us and reality, and it impedes our choices and actions and is no longer fully responsive. Illness forces a reappraisal and in doing so opens up old anxieties and imposes new ones, often including the real threat of death or drastic alterations in lifestyles, such as becoming ventilator-dependent. Fear alone may cripple the ability of the patient to choose. In any consideration of informed consent, the extent of the patient's illness and suffering must always be considered. Adequate interaction with the elderly patient that is necessary for an informed consent consists of a combination of "objectivity" and "cooperation." Cooperation is shown by psychologically reproducing in the mind of the doctor, insofar as possible, the meaning the patient's illness has for him. Without such knowledge, the physician cannot assist a patient in restoring some control over his life, or in understanding his values, both of which are so essential in the decision-making process. The meaning of informed consent is vacuous at best without this objectivity and cooperation. Along with this interaction, the elderly patient must be placed in such a position that throughout his illness he maintains a free choice to decide while he is mentally able to do so. Simply knowing that this freedom exists removes many of the doubts and fears constraining the patient's own sense of autonomy. As a final statement regarding informed consent, we should note that any success by the physician in dealing with problems surrounding the patient's informed consent is always central to the strength of the physician's relationship with the patient. Because of the changing features of this relationship today, the physician should always be ready to implement the steps necessary to maintain the integrity of that relationship. The covenant of faithfulness demands nothing less.

Aged↗
PubMed1986

Refusal of treatment.

The decision regarding refusal of treatment ultimately rests with competent adult patients. When the elderly patients is an inadequate or incompetent decision-maker, in order to protect the interests of the patient, the physician should have some knowledge of the way decisions are and ought to be made, particularly when a decision to forgo life-sustaining treatment is being deliberated. In acquiring this knowledge, the physician needs to develop clear understanding about who has the authority and responsibility to speak for the patient and what standards are to guide the decision-making process involving the incompetent patient. This is not an easy task for any physician. In many instances, the process can become clouded by a host of complex ethical and legal issues that make any decision a questionable one. A beginning point might be the acceptance of the fact that every elderly patient possesses values and goals that are quite unique to him, even though they might seem identical to those held by many other patients. This fact, more than anything else, will help to remove many of the impediments that face the physician during the decision-making process.

Aged↗