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Biomedical subjects

W Shelton

Publications and source records attributed to W Shelton.

12 recordsLinked to original sources
PubMed1999

The basis of informed consent for BMT patients.

During recent decades the doctrine of informed consent has become a standard part of medical care as an expression of patients' rights to self-determination. In situations when only one treatment alternative exists for a potential cure, the extent of a patient's self-determination is constrained. Our hypothesis is that for patients considering a life-saving procedure such as bone marrow transplant (BMT), informed consent has little meaning as a basis for their right to self-determination. A longitudinal study of BMT patients was undertaken with four self-administered questionnaires. Questions centered around expectations, knowledge, anxiety and factors contributing to their decision to undergo treatment. Although the informed consent process made patients more knowledgeable about the treatment, their decision to consent was largely based on positive outcome expectations and on trust in the physician. Informed consent relieved their anxieties and increased their hopes for survival. Our conclusion was that the greatest value of the informed consent process lay in meeting the patients' emotional rather than cognitive needs. When their survival is at stake and BMT represents their only option, the patient's vulnerability puts a moral responsibility on the physician to respect the principle of beneficence while not sacrificing the patient's right to self-determination.

Adult↗
PubMed1999

Can virtue be taught?

Applying standards of virtue that define the "good doctor" in a complex and technologically sophisticated health care system is often challenging and sometimes confusing. What are the characteristics of a "good doctor," who wishes to live up to high ethical and professional standards but who also must live and work in a health care system in which moral ambiguity is pervasive? Medical educators are urgently faced with such questions as their schools try to equip students with the skills and capacities required of the virtuous physician. The author describes how Aristotelian concepts of virtue can be used to guide medical educators in defining and teaching virtue. He then discusses how such traits as the ability to tolerate moral differences and ambiguity, the ability to develop thoughtful individual moral positions, and the capacity to respect and understand various cultural traditions may be what might be considered virtues in today's health care system. A "good" doctor, then, would be someone who is thoughtful, fair-minded, respectful of differences, and committed to his or her professional values.

Academic Medical Centers↗
PubMed1998

A broader look at medical futility.

This paper attempts to provide a descriptive theoretical overview of the medical futility debate. I will first argue that quantitative data cannot alone resolve the medical futility debate. I will then examine two aspects of medical futility, which I call the prospective and immediate, respectively. The first involves making prospective factual and value judgments about the efficacy of proposed medical interventions, while the latter involves making value judgments about ongoing medical conditions where the clinical data are clear. At stake is the nature and scope of individual rights. Thus, I maintain there is an undeveloped aspect to the medical futility debate and, briefly, analyze two political perspectives which give rise to different understandings of medical futility. The view that I will defend is that only a system with defined collective goals can accommodate a normative concept of medical futility. These larger questions are the value options which if unaddressed, may be settled by default of economic grounds.

Aged↗
PubMed1996

Regaining the initiative. Forging a new model of the patient-physician relationship.

The patient-physician relationship has undergone major and increasingly rapid changes in the past 40 years. It has moved from a relationship based on physician paternalism, through one of patient autonomy, to one where the patient and the physician's authority and control over the patient's care are facing significant threats from outside sources. In this article, we examine the historical and social forces that have contributed to these changes and the effects these forces have had on the traditional models of the patient-physician relationship. We present arguments to support our proposal for a patient-physician alliance in the community based on mutual education of physician and patient about health and illness, values and persons, social responsibility, beneficence, trust, and a degree of paternalism. We believe such an alliance offers the best hope for patients and their physicians to regain the initiative in guiding the evolution of health care in a way that preserves the essentials of the therapeutic relationship.

Beneficence↗