Biomedical subjects

R Faden

Publications and source records attributed to R Faden.

23 records · Page 2Linked to original sources

PubMed1977

False belief and the refusal of medical treatment.

May a doctor treat a patient, despite that patient's refusal, when in his professional opinion treatment is necessary? This is the dilemma which must from time to time confront most physicians. An examination of the validity of such a refusal is provided by the present authors who use the case history of a patient refusing treatment, for cancer as well as for a fractured hip, to evaluate the grounds for intervention in such circumstances. In such a situation the patient is said to have a 'false belief' and it is the doctor's duty to try to change that belief in the patient's interest. The false belief is considered here in terms of the liberty principle, the patient's mental competence and on what is called the 'harm principle' (harm to other individuals or to society). Finally the concept of paternalism is examined. The authors conclude that the doctor must attempt to change a false belief, and if this fails he must examine the patient's mental competence to make the decision to refuse treatment. But in the last analysis the doctor may be under an obligation to respect the patient's refusal. Readers might like to look at (or read again) the papers on 'Liberty' and 'Conscience' published in this Journal under the heading Analysis.

Attitude to Health↗

PubMed1976

Efficacy information in contraceptive counseling: those little white lies.

Various procedures for estimating the effectiveness of a method of contraception have been devised. These measures, in turn, have been used in populations which differ widely in their propensity to use contraceptives properly. Therefore, a wide array of failure rates is available in the family planning literature. Unfortunately, because of differences in measurement and in choice of population, a random selection of these reported failure rates will not produce a consistent ordinal or cardinal ranking of methods by their effectiveness. Moreover, such a wide variety or reported rates permits the family planning practitioner to choose selectively in order to maximize the attractiveness of his favorite method(s). By surveying family planning personnel in two major cities, we found that they do indeen appear to place the methods they actively dispense in an extremely favorable position. Specifically, they are biased against the traditional contraceptives, foam and the condom. In this paper, we discuss the theoretical underpinnings of the measurement of effectiveness, report the apparent bias in the levels of contraceptive effectiveness reported to the patient, and finally, recommend a procedure for eliminating the jumble of rates in the literature and the consequent confusion among family planning personnel.

Attitude of Health Personnel↗

PubMedDate not supplied

Release of particulate matter from extracorporeal tubing: ineffectiveness of standard arterial line filters during bypass.

Microemboli resulting from extracorporeal circulation have been considered to be a cause of organ dysfunction after cardiopulmonary bypass. A scanning electron microscopic study was carried out to quantitate the number of nonbiological particles which escape capture by the arterial line filter in a standard extracorporeal circulation circuit. Five different lots of polyvinylchloride (PVC) tubing from the same manufacturer were used in closed circuit extracorporeal pump set-ups consisting of a typical length of PVC tubing, a cardiotomy reservoir, and an arterial line filter (Pall 40 microns (mu)). A liter of Plasmalyte was circulated through this set-up for 15 minutes at 2 liters/minute with the pump head set at almost total occlusion. The circulated Plasmalyte from each pump line was then collected and passed through a 0.22 mu Millipore filter. Numerous particles ranging from 5-40 mu in diameter were observed on the surface of the filters. A mean of 51.2 particles/mm2 of filter was found after the first recirculation period. By extrapolation the mean total number of particles contained in the Plasmalyte was calculated to be 70,943. A second similar 15 minute rinse on the same pump set-ups revealed the release of a mean of 51.0 particles/mm2, or a mean total number of 70,665 particles. Analysis of variance showed no significant difference in the number of particles produced by the first compared with the second recirculation period but there were significant differences (P less than .05) between the numbers of particles produced by the different lots of tubing. This study demonstrates that commonly employed tubing packs and standard roller pump designs for extracorporeal circulation are associated with continuous release of particulate matter (5-40 mu) which is not removed by the arterial line filters most often employed. These particles seem to be released at a constant rate which makes an initial pre-bypass filtration run ineffective. Such particles can only be removed by continuous use of lower porosity filters in the pump circuit. The clinical significance of these large numbers of small particles is unknown, but they may contribute to the multi-organ failure often seen in prolonged (greater than 2 hour) periods of cardiopulmonary bypass.

Equipment Failure↗

PubMedDate not supplied

The Advisory Committee on Human Radiation Experiments. Reflections on a Presidential Commission.

Like the National Commission and the President's Commission, the Advisory Committee on Human Radiation Experiments was formed to carry out specific ethical tasks. Yet the committee also had an "openness" mission, a charge to investigate allegations that the U.S. government secretly exposed Americans to environmental releases of radiation. Eighteen months later- and after sixteen public meetings, more than 200 interviews, and the review of about 400,000 documents-the committee delivered a 925-page report to the president.

Advisory Committees↗

PubMedDate not supplied

Trust, The fragile foundation of contemporary biomedical research.

It is widely assumed that informing prospective subjects about the risks and possible benefits of research not only protects their rights as autonomous decisionmakers, but also empowers them to protect their own interests. Yet interviews with patient-subjects conducted under the auspices of the Advisory Committee on Human Radiation Experiments suggest this is not always the case. Patient-subjects often trust their physician to guide them through decisions on research participation. Clinicians, investigators, and IRBs must assure that such trust is not misplaced.

Advisory Committees↗