Biomedical subjects
J L Bernat
Publications and source records attributed to J L Bernat.
The distinction between active and passive euthanasia.
Explore the source record for details and available documents.
Nutrition and hydration for the terminally ill.
Explore the source record for details and available documents.
Ethical issues in clinical trials.
Explore the source record for details and available documents.
Who's in charge here? Maximizing patient benefit and professional authority by physician limit setting.
Explore the source record for details and available documents.
Patient refusal of hydration and nutrition. An alternative to physician-assisted suicide or voluntary active euthanasia.
Explore the source record for details and available documents.
Suspending do-not-resuscitate orders during anesthesia and surgery.
We outline a model hospital policy that amends existing do-not-resuscitate (DNR) policies to temporarily suspend DNR orders during the perioperative period. The policy amendment is justified because, by accommodating the needs of the DNR patient, the surgeon, and the anesthesiologist, it contributes to the betterment of patient care.
Competent patients with advanced states of permanent paralysis have the right to forgo life-sustaining therapy.
Explore the source record for details and available documents.
Brain death. Occurs only with destruction of the cerebral hemispheres and the brain stem.
Explore the source record for details and available documents.
The Veterans Affairs National Center for Clinical Ethics.
Explore the source record for details and available documents.
How much of the brain must die in brain death?
Explore the source record for details and available documents.
The boundaries of the persistent vegetative state.
Explore the source record for details and available documents.
Ethical issues in brain death and multiorgan transplantation.
There is a consensus in Western society that "brain death" is the medical and legal standard for human death. Patients in persistent vegetative states may have lost their "personhood," but they are not dead. It may be desirable to maintain the physiologic processes of a brain-dead pregnant woman to permit the birth of her child. The determination of brain death and plans for multiorgan transplantation should be conducted independently. It is axiomatic that the multiorgan transplantation donor must be dead. Therefore, living anencephalic infants and patients in persistent vegetative states cannot be organ donors. It is permissable to temporarily maintain the physiologic processes of brain-dead patients in order procure their organs for transplantation. Society will have to decide if money spent on multiorgan procurement and transplantation is better spent in other areas of health care.
Decisions to withhold or terminate treatment.
Decisions to withhold or terminate treatment are common clinical dilemmas in patients dying from diseases of the nervous system. Decision making for such patients must be based upon ethical principles. Under the doctrine of valid consent and refusal, competent patients have the right to refuse life-sustaining therapies. For incompetent patients, this right may be exercised through their previously executed advanced directives or through appointed proxy decision makers. Physicians have the duty to assess the potential benefits and harms of various treatment options and to clearly communicate this information to patients and their proxies in a supportive manner. The authors illustrate the application of ethical principles in neurologists' management of patients in persistent vegetative states, dementia, and end-stage neuromuscular disease.
Neurologic disorders and respiration.
The impact of neurologic disorders on the respiratory system is considered as a functional-anatomic-pathologic sequence. Functional roles of the central, peripheral, and autonomic nervous systems in respiration are described. The effects of pathologic conditions are then discussed based on this functional-anatomic background.
Ethical and legal duties of the contemporary physician.
Explore the source record for details and available documents.
A study of crying in medically and surgically hospitalized patients.
In a prospective study of hospitalized patients referred to a psychiatry consultation service, 46 patients were referred for a presumed diagnosis of depression because crying was a prominent symptom. Psychiatric consultation determined that 20% had a psychiatric disorder only, 33% had a neurological disorder only, 43% had both psychiatric and neurological disorders, and 4% had a previously undescribed entity, "essential" crying. The most common neurological disorder in these crying patients was bilateral hemispheric dysfunction associated with dementia or delirium; the most common psychiatric disorder was major depression. Effective therapy for patients who cry depends on proper identification of the cause of crying.
Ethical and legal aspects of the emergency management of brain death and organ retrieval.
Patients brought to an emergency room with profound brain damage can be determined to be unsalvageable but usually cannot be declared brain dead. Most such patients should be admitted to the hospital for physiologic support and formal brain death determination. There are ethical and legal justifications, discussed in this article, for physicians to encourage the families of such patients to consent for them to be organ and tissue donors.