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Biomedical subjects

N S Jecker

Publications and source records attributed to N S Jecker.

At least 19 recordsLinked to original sources
PubMed1997

Principles and methods of ethical decision making in critical care nursing.

Consideration of the ethical principles of autonomy, beneficence, nonmaleficence, and justice can help to equip critical care nurses to deal with ethical conflicts that arise in nursing practice. Properly understood, these principles do not function as inflexible absolutes, but instead serve as "moral compasses" that help the nurse to get his or her bearings in difficult or uncertain situations. Those who appeal to the four principles should recognize that other cultural traditions may regard other ethical values as central. Finally, to the extent that principlism neglects ethical concerns related to caring and personal relationships, this approach is incomplete. Nurses and others who invoke an ethic of caring can advance ethical understanding by contributing a careful analysis of this concept and its role in ethical decision making.

Critical Care↗
PubMed1996

Medical futility: response to critiques.

Six years ago, we proposed a patient benefit-centered definition of medical futility that included both quantitative and qualitative components. We distinguished between an effect of a treatment that is limited to some part of a patient's body and a benefit that improves the patient as a whole. The quantitative portion of our definition stipulated that physicians should regard a treatment as futile if empirical data show that the treatment has less than a 1 in 100 chance of benefiting the patient. The qualitative portion of our definition stipulated that if a treatment merely preserves permanent unconsciousness or cannot end dependence on intensive medical care, physicians should consider the treatment futile. In this paper, we clarify and modify our original proposal and respond to the following major criticisms: 1) Medical futility is simply an attempt to increase the power of the physician over the patient and to repeal recent hard-gained advances in patient autonomy; 2) no professional or societal consensus has been achieved about the definition of futility; 3) futility is a value-laden determination, the usurpation of which by medicine is inappropriate unless only a so-called value-free or strict physiologic definition of futility is used; 4) the concept of futility is not practically useful because empirical treatment data cannot be applied with certainty to any given patient; 5) futility undermines our pluralistic society and threatens, among other things, the free exercise of religion; and 6) because cost considerations will ultimately dictate all such decisions, futility is an unnecessary concept.

Beneficence↗
PubMed1996

Should a criminal receive a heart transplant? Medical justice vs. societal justice.

Should the nation provide expensive care and scarce organs to convicted felons? We distinguish between two fields of justice: Medical Justice and Societal Justice. Although there is general acceptance within the medical profession that physicians may distribute limited treatments based solely on potential medical benefits without regard to nonmedical factors, that does not mean that society cannot impose limits based on societal factors. If a society considers the convicted felon to be a full member, then that person would be entitled to at least a "decent minimum" level of care--which might include access to scarce life-saving organs. However, if criminals forfeit their entitlement to the same level of medical care afforded to all members of society, they still would be entitled to a kind of "rudimentary decent minimum" granted to all persons on simple humanitarian grounds. Almost certainly this entitlement would not include access to organ transplants.

Altruism↗
PubMed1995

When families request that 'everything possible' be done.

The paper explores the ethical and psychological issues that arise when family members request that "everything possible" be done for a particular patient. The paper first illustrates this phenomenon by reviewing the well known case of Helga Wanglie. We proceed to argue that in Wanglie and similar cases family members may request futile treatments as a means of conveying that (1) the loss of the patient is tantamount to losing a part of themselves; (2) the patient should not be abandoned or disvalued in any way; or (3) the patient is owed special obligations by virtue of the special relationship in which the family and the patient stand. We maintain that families can best express these important messages by caring for patients, rather than by making requests for futile interventions. Likewise, when life-sustaining measures are futile, health providers can best fulfill their professional obligations by assuring patients' dignity and comfort, rather than by applying futile interventions.

Aged↗
PubMed1995

Medical futility and care of dying patients.

In this article, I address ethical concerns related to forgoing futile medical treatment in terminally ill and dying patients. Any discussion of medical futility should emphasize that health professionals and health care institutions have ethical responsibilities regarding medical futility. Among the topics I address are communicating with patients and families, resolving possible conflicts, and developing professional standards. Finally, I explore why acknowledging the futility of life-prolonging medical interventions can be so difficult for patients, families, and health professionals.

Beneficence↗
PubMed1994

United States and Canadian approaches to justice in health care: a comparative analysis of health care systems and values.

The purpose of this study is to compare and contrast the basic ethical values underpinning national health care policies in the United States and Canada. We use the framework of ethical theory to name and elaborate ethical values and to facilitate moral reflection about health care reform. Section one describes historical and contemporary social contract theories and clarifies the ethical values associated with them. Sections two and three show that health care debates and health care systems in both countries reflect the values of this tradition; however, each nation interprets the tradition differently. In the U.S., standards of justice for health care are conceived as a voluntary agreement reached by self-interested parties. Canadians, by contrast, interpret the same justice tradition as placing greater emphasis on concern for others and for the community. The final section draws out the implications of these differences for future U.S. and Canadian health care reforms.

Altruism↗
PubMed1994

Beyond futility to an ethic of care.

The medical futility debate is usually framed as a conflict between physician and patient (or surrogate) over the right to decide whether a particular life-saving treatment is futile and should not be attempted. Arguments on behalf of physician-determined futility emphasize the limits of physicians' obligations; arguments on behalf of patient-determined futility reflect concerns over the potential erosion of recent gains in patient autonomy against medical paternalism. Underlying the arguments of those pressing for "value-free" definitions of medical futility and unlimited obligations of physicians to patients may be fears of covert rationing and patient abandonment. Often overlooked in this debate, both at the bedside and in public commentary, is the ethical duty of the physician to redirect efforts from life-saving treatments toward the conscientious pursuit of treatments that maximize comfort and dignity for the patient and the grieving family. To supplement the limited terms of the futility debate with an ethic of care, physicians should lead in advocating greater awareness of the ethics of care in doctor-nurse interactions, institutional facilities, insurance policies, and public education.

Ethical Theory↗
PubMed1994

Is dying young worse than dying old?

In contemporary Western society, people experience the deaths of older and younger persons differently. We are disposed to feel that the death of a small child is a greater injustice than the death of an older adult, and we experience correspondingly greater sorrow, anger, regret or bitterness when a very young person dies. This article examines these responses critically to determine whether they are backed by ethical considerations that reason can discern and defend. We contrast contemporary attitudes with those of ancient Greece and show the relevance that different attitudes toward death have for health care decision making.

Age Factors↗