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Biomedical subjects

Marshall B Kapp

Publications and source records attributed to Marshall B Kapp.

At least 19 recordsLinked to original sources
PubMed2006

Medicaid planning, estate recovery, and alternatives for long-term care financing: identifying the ethical issues.

In anticipation of the escalating costs of long-term care, consumers and the federal and state governments are engaging in a variety of strategies intended to preserve the financial solvency of the respective parties. For the consumer, this may mean planning in a way designed to maximize one's potential future eligibility for government support, whereas the federal government tries to limit those planning activities inspired by public benefits considerations and the states attempt to recover their long-term care expenses from the estates of deceased consumers whose long-term care needs the state had earlier supported. All of these strategies have important and controversial public policy implications. The public policy debate surrounding these strategies ought to be ethically informed. This article sets out to identify and outline some of the main ethical questions engendered by individual Medicaid planning on one hand, and state estate recovery efforts on the other. It concludes that neither of these approaches to the challenge of long-term care financing is very ethically palatable.

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PubMed2004

Protecting human participants in long-term care research: the role of state law and policy.

There has been substantial recent activity addressed at the challenge of protecting the rights and welfare of vulnerable human participants in various kinds of research protocols, on one hand, without unduly impeding the conduct of research that promises findings that may substantially improve health and quality of life for many beneficiaries of research, on the other. Many of the emerging recommendations for improved participant protection are relevant to, and in some cases explicitly targeted at, vulnerable older persons, including long-term, chronically dependent nursing home and home health patients, who may be approached by investigators. Thus far, virtually all of the discussion and recommendations regarding research participant protection pertain to possible legal and policy changes at the federal level. Yet, both current federal law and emerging policy recommendations defer, either expressly or by default through their silence, on some very important matters about research participation, especially regarding informed consent, determinations of decisional capacity, and surrogate decision-making authority, to the laws of individual states. This article analyzes and interweaves recommendations regarding the role of state law and public policy in protecting older persons who are or may become participants in long-term care research projects.

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PubMed2004

Altering the home care agency/client relationship: notice requirements.

Many older and disabled individuals regularly receive valuable services from home health agencies (HHAs). The unilateral termination or reduction of such services by an HHA may exert a significant impact on the life of a client who has come to depend on those services. The prerogatives of Medicare-certified HHAs to terminate their relationships with clients are constrained today not only by contract and tort law principles, but also by federal statutes and regulations establishing Conditions of Participation, including provisions concerning clients' rights. A recent important federal judicial decision interpreted and expanded the legal responsibilities of HHAs to provide formal notice to their Medicare clients before terminating or reducing home health care services to those clients, regardless of the reason for ending or altering the relationship. This article critically discusses the background, holding, and practice implications of the 2004 Lutwin v. Thomson decision, which imposes these notice requirements on HHAs.

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PubMed2003

Legal anxieties and end-of-life care in nursing homes.

Many persons spend their final days as nursing home residents. It has been suggested that one set of factors powerfully and unfavorably influencing the quality of end-of-life (EOL) care provided in American nursing homes involves the anxieties that nursing home providers experience regarding potential negative legal entanglements and repercussions associated with the provision of EOL care to their residents. This article critically examines the hypothesis that the quality of EOL medical care provided in nursing homes often is skewed in a perverse way because providers are driven unduly by legal apprehensions. The author offers practice and policy recommendations for trying to resolve or mitigate the tension present between legally defensive practice (real or perceived) by nursing homes, on one hand, and ethically optimal EOL care, on the other.

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PubMed2002

Regulating hematology/oncology research involving human participants.

The conduct of hematology/oncology research, particularly clinical trials involving human participants, is an extensively regulated enterprise. Professionals in the specialty of hematology/oncology have important stakes in the success of biomedical research endeavors. Knowledge about and compliance strategies regarding the pertinent regulatory parameters are essential for avoiding negative legal repercussions for involved professionals. At the same time, there is a need to be aware of and actively resist the danger that strong [legal] protectionism might inadvertently result in undermining physician investigators' sense of personal moral responsibility in the conduct of human experiments. For all the limitations of that virtue in the protection of human subjects, it is surely not one that we would want medical scientists to be without [47]. Members of the potential participant pool, financial sponsors, and the general public must be convinced that everyone involved in the research enterprise is committed to operating within acceptable legal and ethical boundaries if the atmosphere of confidence and trust that is indispensable to the continued process and progress of investigation aimed at extending and improving quality of life for all of us in the future is to continue and flourish [48].

Cytogenetics↗
PubMed2002

Evidence-based medicine and informed consent.

The author applauds the paradigm shift in medical education and practice toward evidence-based medicine. However, he maintains that an important part of this shift should be a careful consideration of its implications for the physician's legal and ethical obligations to sufficiently inform patients about the nature of proposed medical interventions. Should the traditional informed-consent requirement be expanded to mandate that the physician also disclose the basis or reasons for the physician's expectations about likely benefits? Particularly, should the physician have to reveal whether a recommendation is based on scientifically analyzed evidence of efficacy or instead on the sorts of factors (custom, habit, gut instinct, personal impressions and experience) that have influenced much of medical practice in the past in the absence of relevant evidence? What should the physician tell the patient when the evidence base regarding a specific intervention is just beginning to be developed, is ambiguous, or is engulfed in controversy? The author examines the implications of these questions, and cautions that while the trend to evidence-based medicine is commendable, careful consideration of patients' proper roles regarding evidence-based medicine-as both recipients of and decision makers about their own proven and unproven forms of medical care-should not be overlooked.

Education, Medical, Undergraduate↗
PubMed2002

Health care rationing affecting older persons: rejected in principle but implemented in fact.

Health care resources are finite and, therefore, need to be rationed among potential users. Over the past decade and a half in the United States, a variety of explicit, official rationing schemes have been proposed, including some in which chronological age would play a significant role. For ethical and political reasons, it is very unlikely that any age-based rationing schemes will be adopted explicitly and officially. However, various de facto forms of health care rationing are occurring at present. This article outlines the implications of payer behavior, physician practice patterns, the development of evidence-based clinical practice parameters or guidelines, and reliance on consumer choice of health plans as unofficial and generally unacknowledged mechanisms of health care rationing that may exert an important impact on the accessibility of health services for older persons.

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PubMed1994

Proxy decision making in Alzheimer disease research: durable powers of attorney, guardianship, and other alternatives.

Individuals in advanced stages of Alzheimer disease are incapable of giving or refusing legally or ethically valid consent to participation in biomedical and behavioral research protocols. Yet, many research protocols aimed at better treatment of persons with this disease can be conducted usefully only if such individuals are themselves involved as human subjects. This dilemma raises difficult issues of personal autonomy and beneficent motives. This article discusses several potential proxy decision-making mechanisms regarding research participation in light of the relevant legal and ethical concerns. The analysis is organized according to a matrix approach that takes into account procedural and substantive questions as well as the specific type of research protocol under consideration.

Advance Care Planning↗