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Biomedical subjects

J J Paris

Publications and source records attributed to J J Paris.

At least 19 recordsLinked to original sources
PubMed2006

Approaches to end-of-life decision-making in the NICU: insights from Dostoevsky's The Grand Inquisitor.

For many parents stopping life-sustaining medical treatment on their dying infant is psychologically impossible. Dostoevsky's insights into human behavior, particularly the fact that individuals do not want the anxiety and guilt associated with responsibility for making difficult decisions, might change the way physicians approach parents for permission to withdraw life-prolonging medical interventions on dying infants.

Decision Making↗
PubMed2005

Resuscitation of the preterm infant against parental wishes.

Over the past 40 years, the norms on who is to make treatment decisions for newborns, and on what standards, have been significantly altered and revised. Today the standard for treatment of newborns is the "best interest" of the child. A recent ruling of the Texas Supreme Court authorizing a doctor to resuscitate a potentially viable very premature newborn over the parents' objection is a challenge to that standard.

Decision Making↗
PubMed1997

Parental right to determine whether to use aggressive treatment for an early gestational age infant: the Messenger case.

Manslaughter charges were brought against Dr. Gregory Messenger, a Michigan (USA) dermatologist, for removing his extremely premature infant son from a ventilator in the neonatal intensive care unit. Prior to delivery the neonatologist had told the parents that at the infant's age there was a 50-70% mortality and that if the child did survive there was a 20-40% chance of severe intraventricular hemorrhage. The newborn infant had been placed on mechanical life support despite the explicit instructions of the parents that they did not want aggressive or resuscitative measures used on their 780g., infant born at 25 weeks gestational age. The defendant argued that given the child's precarious medical status, it was the right of the parents to determine whether or not to institute aggressive medical interventions. The jury acquitted the father of all charges.

Adult↗
PubMed1996

Physicians' refusal to provide life-prolonging medical interventions.

The intense and ongoing debate on physicians' right to refuse requested life-prolonging medical interventions highlights one of the emerging problems in modern medicine: the limits, if any, to a patient (or proxy's) claim to requested treatment. How is the physician to respond to requests for treatment believed by the physician to be futile, ineffective, or inappropriate? Three cases, Baby L, the extracorporeal membrane oxygenation (ECMO) baby, and Baby K, help focus the ethical and legal issues in this debate.

Anencephaly↗
PubMed1996

Parental discretion in refusal of treatment for newborns. A real but limited right.

Manslaughter charges were brought in Lansing, Michigan against Gregory Messenger, a local dermatologist, for removing his extremely premature infant son from a ventilator in a neonatal intensive care unit. The issue in the case was the degree of intervention required for the newborn for whom the parents had been counseled that there was a 50% to 70% mortality and that if the child did survive, there was a 20% to 40% chance of severe intraventricular hemorrhage and a likelihood of substantial respiratory problems. In light of those grim data, the parents requested that no aggressive measures be undertaken. The neonatologist instructed her physician's assistant to ventilate if the child was "vigorous." The homicide charge was based on Gregory Messenger's failure to provide proper medical treatment for his infant son.

Dissent and Disputes↗
PubMed1995

"Playing God" and the removal of life-prolonging therapy.

"Playing God" is the charge frequently leveled when physicians and patients agree to withdraw life-sustaining medical treatments and let the patient die. The accusation rings hollow in the context of four hundred years of moral reflection on the duty of an individual to undergo medical treatments to preserve life. From the teachings of Soto and Banez in the 16th century through the President's, Commission 1983 report 'deciding to forego life-sustaining treatments' there is a clear and constant teaching that though life is sacred it is not an absolute and our moral duty to preserve it is limited and based on rational reflection. No patient need undergo any treatment of procedure that is "disproportionately" costly, burdensome, or painful. The assessment of whether to accept or reject a proposed treatment is in part subjective and belongs to the individual patient. The only remaining issue is how to make that judgement for those unable to speak for themselves.

Euthanasia, Active↗
PubMed1994

Stopping dialysis of an incompetent patient over the family's objection: is it ever ethical and legal?

Decisions to stop dialysis or other life-sustaining treatments for incompetent patients are among the most difficult ethical problems faced by physicians and families. This observation is verified by the large number of court cases and the increasing frequency of ethics consultations on these issues. In such instances, in the absence of an advance directive, the usual practice for physicians is to turn to the patient's family for direction on whether to start, continue, or withdraw the treatment. They do so on the presumption that the family best represents the patient's interests. This presumption may not always be correct. A case is presented in which the family's insistence on continued dialysis was contrary to the patient's previously expressed wishes and the treating physician's assessment of the patient's best interests. It is asserted that, in such situations, after thorough conversation with the family, consultation, documentation, and an unsuccessful attempt to transfer the patient's care to another physician, nephrologists have an ethical obligation and legal right to override the family's decision and to stop dialysis. The ethical obligation is supported by the principles of respect for persons, beneficence, and nonmaleficence. The legal right is grounded in common law and state statutes.

Aged↗