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Biomedical subjects

L B McCullough

Publications and source records attributed to L B McCullough.

At least 73 records · Page 4Linked to original sources
PubMed1996

Responding to the ethical challenges posed by the business tools of managed care in the practice of obstetrics and gynecology.

We provide a preventive ethics approach that equips obstetrician-gynecologists to respond proactively to the ethical challenges posed by the business tools of managed care. This approach is based on an ethical analysis of medicine as a fiduciary profession. This analysis identifies four virtues: self-effacement, self-sacrifice, compassion, and integrity. We show how these four virtues can be applied proactively in response to conflicts of interest in how physicians are paid and strict control of clinical judgment and practice, the two main business tools of managed care.

Ethics, Medical↗
PubMed1996

Conflicts between physicians and patients in non-elective cesarean delivery: incidence and the adequacy of informed consent.

A study was undertaken in 372 consecutive patients undergoing non-elective cesarean delivery to explore the incidence and nature of conflicts between physician and patient surrounding the decision to undergo non-elective cesarean delivery; to examine the adequacy of informed consent at the time of non-elective cesarean delivery; and to describe the importance of a preventive ethics approach to non-elective cesarean delivery. During a 6-month interval, all patients who underwent non-elective cesarean delivery and their physicians were asked to take part in a survey in the early postpartum period concerning their response to recommendations for cesarean delivery. The survey included demographics as well as questions pertaining to informed consent and the presence and nature of patient-physician conflict. Of the 326 patients who were interviewed, 319 (98%) agreed to the recommendation for non-elective cesarean delivery and 7 patients (2%) initially disagreed. Reasons for disagreeing included: feared surgery (4 of 7), needed husband's approval (1 of 7), and questioned the medical necessity of surgery (2 of 7). In all 7 cases of initial disagreement, cesarean delivery was eventually performed with the patient's consent. The mean age of patients who initially disagreed was younger (24.7 +/- 6) than that of those who agreed (31.0 +/- 4 [p < 0.05]). Conflicts were present in 7 of 113 clinic patients and 0 of 213 private patients (p < 0.05). Of those surveyed, 26 (8.7%) indicated that they did not have adequate input in the decision for non-elective cesarean delivery. Patients with inadequate input expressed significantly more concerns with regard to the effect of surgery on their own health (p < 0.05) as well as its effect on the baby (p < 0.05). Our findings suggest that even though the incidence of physician-patient conflict about non-elective cesarean delivery was quite low, a significant number of patients (1 in 12) may have reservations concerning the informed consent process at the time of non-elective cesarean delivery. Patients with reservations are more likely to have greater concerns with regard to maternal and fetal risks, suggesting that a more detailed risk disclosure prior to the procedure is warranted for all pregnant patients. Perhaps by incorporating the preventive strategies discussed, the adequacy of informed consent and therefore the patient's autonomy could be enhanced, thus diminishing patient reservations and preventing physician-patient conflict in the intrapartum period.

Adult↗
PubMed1996

Common ethical dilemmas encountered in the management of HIV-infected women and newborns.

The clinical management of the HIV-infected pregnant woman and newborns involves multifaceted ethical challenges. We have argued that rights-based approaches, based on a civil rights model, are not adequate to clinically address these challenges. We have argued instead for a more nuanced ethical framework that emphasizes the beneficence-based obligations of the physician of the pregnant woman, to the fetal patient, and to the newborn, as well as the beneficence-based obligations of the pregnant woman to the fetal patient and to the newborn. The ethical principle of respect for autonomy shapes the counseling process about termination of pregnancy, contraception, and advance directives.

Adolescent↗
PubMed1995

Sexually transmitted disease prevention services for female chronically mentally ill patients.

Chronically and variably impaired autonomy makes women with chronic mental illness particularly vulnerable to contracting sexually transmitted diseases (STDs) including AIDS. A lack of female controlled protective devices also adds to the vulnerability of these patients. In this context, the authors make recommendations for the design of clinically comprehensive and ethically justified programs to minimize the risk of mentally ill women for STDs. When female chronically mentally ill patients are at risk of STDs, barriers to the exercise of their autonomy must be identified and clinically treated. Preventive clinical interventions can also be usefully augmented by educational strategies and facilitate patients' communication and behavioral skills, particularly in order to enable them to abstain from unwanted sex or to make prospective male partners wear a condom. Outreach efforts to the male partners of female patients and to the homeless mentally ill may also be required. Preventive services could be integrated and coordinated with STD clinics, substance abuse treatment programs and family planning programs.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Three ethically justified indications for selective termination in multifetal pregnancy: a practical and comprehensive management strategy.

The authors provide an ethical justification for three indications for performing selective termination of multi-fetal pregnancies. These indications are (1) achieving a pregnancy that results in a live birth or one or more infants with minimal neonatal morbidity and mortality, (2) achieving a pregnancy that results in a live birth of one or more infants without antenatally detected anomalies, and (3) achieving a pregnancy that results in a singleton live birth. This ethical justification is based on two basic approaches to obstetric ethics that emphasize that these indications must be established on the basis of informed consent. The authors underscore the importance of matters of private conscience and demonstrate the consistency of ethical justification with existing public policy in the United States.

Beneficence↗
PubMed1995

Routine obstetric ultrasound.

A detailed review of the literature reveals that routine obstetric ultrasound has value in providing more accurate gestational dating and in the diagnosis of fetal anomalies. The recent RADIUS study, which has concluded that routine obstetric ultrasound is of no clinical benefit, is critically analyzed, focusing on four areas: the applicability of the results to the general population, the appropriateness of the outcome parameters, the quality of the ultrasound provided, and the issue of excessive cost. Finally, an ethical analysis of the role of routine obstetric ultrasonography is provided, focusing on the principles of beneficence and respect for autonomy. The offering obstetric ultrasound is necessary in both beneficence-based and autonomy-based ethical analyses, and the use of routine ultrasound is supported from an analysis of the scientific data.

Congenital Abnormalities↗
PubMed1995

What is obstetric ethics?

This paper provides an overview of obstetric ethics as an essential clinical tool. First, we define two basic ethical principles, beneficence and respect for autonomy. Second, on this basis, we provide an account of two ethical senses of the concept of the fetus as a patient. On the basis of this clinical concept we identify its clinical implications for directive versus non-directive counseling for fetal benefit. Third, we provide the reader with tools for critically evaluating the literature on obstetric ethics.

Beneficence↗
PubMed1995

Ethical implications for early pregnancy of the fetus as patient: a basic ethical concept in fetal medicine.

The viable fetus is a patient. The previable fetus, including the in vitro embryo and the near-viable fetus, is a patient solely as a function of the exercise of the woman's autonomy. Directive counseling of the pregnant woman for fetal benefit is appropriate only when the fetus is a patient and must take account of the presence and severity of anomalies, extreme prematurity and beneficence-based and autonomy-based obligations to the pregnant woman.

Embryo Transfer↗