Biomedical subjects

J Arras

Publications and source records attributed to J Arras.

4 recordsLinked to original sources

PubMed1993

Ethical issues in emergency care.

The ethical framework established for most health care decision making should apply to elderly patients in the ED, i.e., the authority to decide should rest either with the competent patient or, in case of incapacity, with the patient's surrogate. Whenever possible, ethical dilemmas in the ED should be prevented from occurring through the judicious use of advance directives crafted in the doctor's office. DNR orders should be based upon the wishes of a competent patient or upon a surrogate's estimation of the patient's values and best interests. Because advanced age is a predictor of poor outcome for most hospitalized elderly patients, physicians should educate themselves about the actual benefits and burdens of CPR in this population and share this information with patients and surrogates. In case physicians determine that CPR would be futile in a strict sense, they have no ethical or legal obligation to administer it, even if requested to do so; however, they have an ethical obligation to inform the patient or family of the reasons for the decision and should offer the family the option of dispute mediation in case of disagreement. If the patient arrives in the ED capable of making decisions but lacking an advance directive, it is the responsibility of physicians and nurses to educate the patient concerning the respective merits and drawbacks of the living will and health care proxy. Except for those elderly patients who lack family or friends or who do not wish to burden others with such decisions, the health care proxy, supplemented perhaps to some extent by oral or written specific directives, appears to be the best approach. Attention to these important problems bearing on the substance and procedures for life and death decision making in the ED should not obscure the manifest injustice of the context in which these decisions are often made. At many inner-city hospitals serving a largely poor and elderly clientele, the ED has become nothing short of a torture chamber for many critically ill elderly persons. An ethical framework for decision making, no matter how urgently needed, will not address the unnecessary pain and confusion of frail elderly patients subjected to an impersonal, overcrowded, and depersonalizing environment.

Advance Directives↗

PubMed1989

Ethical issues in the use of anencephalic infants as organ donors.

For many, the ethical issues raised in the previous sections are sufficient to justify opposition to tampering with either the dead-donor rule or the definition of death in general and the use of anencephalic infants as organ donors in particular regardless of how many organs could be procured. Others will see it as a question of balancing the relative costs and benefits of the proposal. Given, the likely bad consequences and meager benefits, these protocols are difficult to justify on those grounds as well. The proposals of waiting until brain death has occurred also pose some serious, though not necessarily insurmountable, ethical problems. With supportive care, however, anencephalic infants do not become brain dead in the first week of life. Given the declining incidence of anencephaly, the issue regarding anencephalic infants will probably become moot in the next few years. As the need for organ donors continues to grow, we will undoubtedly be faced with future proposals to harvest vital organs from other "unique" categories of dying or severely impaired patients. We believe that the current dead donor rule and the strict "whole-brain" definition of death are sound public policy and good ethics and should remain the cornerstone of future decisions in this field.

Anencephaly↗

PubMed1987

Teaching medical ethics in perinatology.

The past 15 years has seen the resurgence of an interest in biomedical ethics and an awareness of the importance of teaching this discipline in medical curricula at varying levels. Physicians and philosophers can work together to achieve an integration of clinical case material and philosophical theory, in order to teach bioethics optimally. This article describes a clinical program of ethics rounds for residents and fellows training in neonatal and perinatal medicine.

Ethical Analysis↗

PubMed1985

A proposal for cadaver organ procurement: routine removal with right of informed refusal.

In order to alleviate the shortage of vital organs for transplant, we propose a system of routine removal of cadaver organs with an option of informed refusal by family. Unless an individual registered an objection during his or her lifetime, or unless the family objected to the procedure, clinicians would be permitted routinely to salvage vital organs for transplant. Our proposal charts a middle path between the current ineffective policy based on "encouraged voluntarism" and "presumed consent" policies that promise effectiveness at the cost of violating traditional ethical and legal principles. In this article, we analyze the failure of the current regime, articulate a policy of routine removal subject to the right of informed refusal, and defend this policy against several possible objections.

Cadaver↗