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Can physicians lead other physicians into the future?

This article reflects upon some of the dynamics that prevent physicians from successfully engaging change. Physicians are enculturated to the competitive and hierarchical, and to value personal autonomy. These traits promote distrust and inhibit the formation of collaborative relationships. At this time of growing complexity, when most other industries are developing styles of work based on teamwork, worker empowerment, cross training, and information sharing, physicians cling to the metaphor of the ship's captain, a lone decision-marker and authoritarian possessor of grand knowledge. And yet, in order to lead, physicians need to learn to work differently and nurture a more collaborative approach. The author's blueprint for change includes: Stop trying to manage consensus; commit to measured accountability; think systemically; don't make the mistake of thinking that people will follow because you are right; and, most importantly, create relationships based on shared purpose and principles.

Decision Making, Organizational↗

[Mistaken chances for living donor procurement? On the ethical aspects of a previously neglected area of transplantation surgery].

The problem of living donor, rarely discussed until now, arouses greater interest. The medical risks for the donor seem to be lower than first presumed. Within an ethical view the free and informed consent and in consequence a preceding consultation is essential. Thus, if the personal autonomy is guaranteed, the living donation as an act of human assistance is ethical acceptable.

Ethics, Medical↗

The ethics of advanced technology.

Clinicians are faced with the consequences of advanced technology in every aspect of their practice--from computerized documentation to local wound care treatments to clarifying information located by patients on the Internet. Americans are preoccupied with the promise of new and different technologies. The technological imperative describes the human drive to use technology once it becomes available simply because it is available. This raises a number of patient care issues--including ethical issues. Nonmaleficence and respect for personal autonomy are addressed in this ethical analysis of advanced technology. Opportunities for wound care clinicians are discussed herein.

Ethics, Medical↗

[Vertigo in the elderly: otorhinolaryngologic approach].

Dizziness is a common but little understood ailment of old people. Its presence is the origin of an important incapacity associated with lack of personal autonomy. Clinical and electronystagmographic findings of aging individuals enduring imbalance and coming to our Department allowed us to accept that those cases in which the cause could be identified it was on clinic data, being of scarce utility the other exams done.

Age Factors↗

The individualistic nature of healthcare: challenges for public policy.

Modern healthcare in America is thought to be strongly individualistic in nature in that it largely focuses on curative treatment of individuals instead of preventive medicine that would affect whole segments of the population. This article describes the terms individualism, entitlement, and respect for personal autonomy within the context of ethically sound public policy formation.

Health Policy↗

Informed consent, informed refusal, informed choice--what is it that makes a patient's medical treatment decisions informed?

Informed consent is the fundamental ethical and legal doctrine that protects the patient's rights of personal autonomy and bodily self-determination. An adjunct to the doctrine of informed consent advanced by some is the notion of informed refusal. According to advocates of this concept, incoherent, unconscious, or otherwise incapacitated patients cannot make informed treatment choices because such patients cannot receive a full and current explanation of their health problems and treatment options. This, in turn, raises serious questions about what it is that makes a patient's treatment decisions--whether consents or refusals--informed. Is current, detailed information about the patient's medical condition and treatment options an ethical and legal prerequisite? Can non-medical values and concerns of the patient ever suffice to make the patient's treatment choices informed? How does the concept of informed refusal affect the use of health-care advance directives? This paper will address these important questions.

Christianity↗

Anticruelty care: commentary.

The anticruelty policy is a best-interests test for treatment plans including decisions to forgo life-sustaining therapy for certain incompetent patients. In connection with specific proposed therapy, the policy requires no reference to the patient's unknowable values, subjective experiences, or quality of life. The decision to undertake a treatment plan derives from the caregiver's knowledge of burdens and benefits of that treatment when used in caring for the competent or for those incompetents capable of growth or repair. The caregiver should weigh the potentially cruel effects of treatment against the likelihood of reducing suffering or encumbrance with the treatment. The terms "burden" and "benefit," in fact, are replaced by the terms "cruelty" and "beneficence," as the relevant opposing outcomes that must be weighed. Thus, the anticruelty policy shifts our scrutiny from experiences of the patient that we cannot evaluate to the proposed actions of the competent decision makers and caregivers. Notably, it is a protreatment policy when the goals of medicine are attainable; and it is an anticruelty policy when they are not. The policy does evaluate the world of the patient to the extent that it requires a judgment based upon external appearances about patient pleasure or happiness in living. It presumes to universalize larger societal values about cruelty, beneficence, compassionate concern for the helpless, and certain rights of individuals. And it presumes to universalize on the patient's behalf specific medical values about hopeless injury, timely death, the goals of medicine, and cruelty, which should remain open to societal discussion and revision. The presented definition of hopeless injury does not require brain death, coma, or persistent vegetative state. Specifically, the policy holds that death is timely for a patient with hopeless injury, and that prevention of death for such patients is not a goal of medicine but a cruelty.

Aged↗

Deciding for others.

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Congenital, Hereditary, and Neonatal Diseases and ↗