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Biomedical subjects

J C Moskop

Publications and source records attributed to J C Moskop.

At least 19 recordsLinked to original sources
PubMed2000

Determination of "futility" in emergency medicine.

The practice of emergency medicine routinely requires rapid decisionmaking regarding various interventions and therapies. Such decisions should be based on the expected risks and benefits to the patient, family, and society. At times, certain interventions and therapies may be considered "futile," or of low expected likelihood of benefit to the patient. Various interpretations of the term "futility" and its practical application to the practice of emergency medicine are explored, as well as background information and potential application of various legal, ethical, and organizational policies regarding the determination of "futility. "Decisions regarding potential benefit of interventions should be based on scientific evidence, societal consensus, and professional standards, not on individual bias regarding quality of life or other subjective matters. Physicians are under no ethical obligation to provide treatments they judge to have no realistic likelihood of benefit to the patient. Decisions to withhold treatment should be made with careful consideration of scientific evidence of likelihood of medical benefit, other benefits (including intangible benefits), potential risks of the proposed intervention, patient preferences, and family wishes. When certain interventions are withheld, special efforts should be made to maintain effective communication, comfort, support, and counseling for the patient, family, and friends.

Emergency Service, Hospital↗
PubMed1999

Informed consent in the emergency department.

This article reviews the doctrine of informed consent to treatment, with particular attention to its role in the emergency department. The article begins with a brief look at the moral and legal foundations of informed consent. The article then examines the three essential features of informed consent, patient capacity, disclosure of information, and voluntariness. After a review of five exceptions to the duty to obtain informed consent, the article concludes with a brief summary of issues of special significance for emergency physicians.

Adult↗
PubMed1998

A moral analysis of military medicine.

This paper offers a brief examination of the moral status of military medicine. Military physicians assume one set of obligations as physicians, including obligations of beneficence, nonmaleficence, and respect for autonomy. They assume another set of obligations as members of an armed service, such as maintaining combat readiness and maximizing the fighting strength of the force. These different obligations may come into conflict, but so may the obligations of civilian physicians in a variety of practice settings. In military service, however, both patients and physicians give up a greater measure of autonomy over their choices and actions than they do in most other settings. Because of both their increased risks and their decreased ability to make choices, military personnel can be viewed as a vulnerable population. Military physicians' ability to act on their behalf, however, is limited by the physicians' obligations to pursue military goals and to obey the lawful orders of superior officers. A physician's decision to enter military service is thus a morally weighty one that bears reflection on the practices of the military service to which one is pledging obedience.

Delivery of Health Care↗
PubMed1996

Knowing the score: using predictive scoring systems in clinical practice.

Outcome scores have been promoted as adjuncts to clinical decision making, especially when further care is thought to be futile. The Pediatric Risk of Mortality score is used to calculate the risk of mortality for patients admitted to pediatric intensive care units. In this article the Pediatric Risk of Mortality score in evaluated for its ability to contribute to individual patient care decisions in the context of clinical practice. Through analysis several features of the Pediatric Risk of Mortality score were identified that require discretion if the score is to be used in decisions involving individual patients. These features include variability and bias introduced in data collection and data presentation. Also, outcome scores do not allow for the incorporation of patient and family values into the decision process. Outcome scores can provide some adjunctive information to clinicians, but they should be used with caution when making patient care decisions. Use of Pediatric Risk of Mortality scores in clinical practice must be tempered with a knowledge of the limitations of the scores, individual patient variability, the conditions under which the scores have been validated and collected and, most importantly, an awareness that outcome scores do not take into account the caregiver and patient values that are inherent in any treatment decision.

Child↗
PubMed1995

From futility to triage.

Basic disagreements about what makes human life valuable hinder use of the concept of futility to decide whether it is appropriate to continue life support for one in a permanent state of unconsciousness, or to provide intensive medical care to one in the last stages of a terminal illness (the "paradigm cases"). Triage planning (the process of establishing criteria for health care prioritization) is an attractive alternative framework for addressing the paradigm cases. Triage planning permits society to see the cases in the context of diverse moral perspectives, limited resources, and competing health care demands. Furthermore, at least one essential question posed by the paradigm cases is whether treatment is wasteful, and triage planning is a useful model for identifying and eliminating wasteful medical care. The authors describe how triage planning can be implemented to address the paradigm cases, and conclude that it offers one way of moving debate about these cases beyond futility.

Consensus↗
PubMed1990

An ethics curriculum for teaching emergency medicine residents.

Instruction in medical ethics has become standard in undergraduate medical education within the past decade; more recently, several specialty boards have formally endorsed ethics teaching and evaluation for residents as well. However, the current emergency medicine Core Content, representing emergency medicine's central body of knowledge, makes no specific mention of ethics. An ethics curriculum is proposed to remedy this gap in the emergency medicine residency curriculum. Issues frequently encountered in the emergency department are emphasized, and topics include moral foundations of clinical medicine, the unique ethical concerns of emergency medicine, patient competence, informed consent and refusal of treatment, truthfulness, confidentiality, foregoing life-sustaining treatment, duty to provide care, moral issues in disaster medicine, allocation of health care, and research and teaching involving human subjects. Educational objectives and readings for each of these topics are presented along with sample case scenarios to be used in a small group discussion format.

Curriculum↗
PubMed1990

AIDS and hospitals: the policy options.

This article examines several policy decisions faced by American hospitals as they respond to the current AIDS epidemic. The article reviews the basic moral responsibilities of the hospital, the health care needs of HIV-positive and AIDS patients, and the risk of acquiring HIV infection in the hospital setting. It examines the hospital's responsibility to care for AIDS and HIV-positive patients, AIDS infection-control practices, and hospital policy regarding HIV-positive health care professionals.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Unorthodox medicine.

Explore the source record for details and available documents.

Complementary Therapies↗
PubMed1988

AIDS and public health.

After briefly stating the significance of acquired immunodeficiency syndrome (AIDS) for public health, this paper considers programs or proposals to control the spread of AIDS in the following eight general areas: (a) education; (b) distribution of sterile needles; (c) screening and treatment of blood, blood products, and other tissues; (d) voluntary and mandatory screening of persons for evidence of infection; (e) reporting; (f) contact tracing; (g) isolation and other restrictions on freedom of movement or association; and (h) physical marking of persons with AIDS. Significant moral issues within each of these areas are discussed, and the overall justifiability of various proposals is examined.

Acquired Immunodeficiency Syndrome↗
PubMed1987

The moral limits to federal funding for kidney disease.

In the current era of cost-containment, Congress may reconsider its support for the End-Stage Renal Disease Program. Substantial reductions in funding for this program could be made by eliminating non-beneficial, marginally beneficial, and relatively inefficient modes of treatment. These measures, however, will only postpone the inevitable day when clearly beneficial treatment must be withheld.

Capitalism↗