scholarly journals Ethical issues in stroke management

2020 ◽  
pp. 10.1212/CPJ.0000000000000925
Author(s):  
James L. Bernat ◽  
Timothy G. Lukovits
Keyword(s):  
Ethical Issues ◽  
Treatment Preference ◽  
Treatment Refusal ◽  
Surrogate Decision Maker ◽  
Stroke Management ◽  
Nonfluent Aphasia ◽  
Decision Making Capacity ◽  
Life Sustaining Treatment ◽  
Surrogate Decision ◽  
Hemispheric Infarction

A variety of ethical issues may arise in the management of patients with stroke.1 The adequacy of informed consent may be questioned in the incapacitated patient with acute stroke for whom IV alteplase administration is planned despite the absence of a lawful surrogate decision-maker. The decision-making capacity of a patient with a recent dominant hemispheric infarction causing nonfluent aphasia may become an issue when he appears to understand but cannot communicate his treatment preference. Neurologists may be unsure whether to provide medical hydration and nutrition to an elderly patient admitted with a massive intracranial hemorrhage and incipient herniation whose advance directive states that life-sustaining treatment is to be withheld in the event of a hopeless prognosis. A patient with chronic locked-in syndrome from pontine infarction may order that further life-sustaining treatment be withdrawn but her neurologist may be unsure of the ethical adequacy of her treatment refusal because of communication limitations.

Fostering medical staff reflection on the technological alienation of parents in the NICU

2021 ◽  
pp. 147775092110618
Author(s):  
Abram Brummett ◽  
Annie B. Friedrich
Keyword(s):  
Medical Staff ◽  
Moral Distress ◽  
Ethical Issues ◽  
Treatment Refusal ◽  
Healthy Newborn ◽  
Incurable Condition ◽  
Life Sustaining Treatment ◽  
Terminal Diagnosis ◽  
The Relationship

We describe a case of parents refusing a tracheostomy for an otherwise healthy newborn. The refusal was not honored because permitting the refusal would have violated state law, which required a child to have a qualifying condition (e.g. a terminal diagnosis, permanent unconsciousness, incurable condition with severe suffering) to remove or withhold life-sustaining treatment. However, this case strained the relationship between the parents and medical staff, who worried about sending the newborn home with a tracheostomy where she was not wanted. While many ethical issues arise in treatment refusal cases like this, we focus on the opportunity for ethicists to help the medical staff reflect on the technological alienation of the parents, which may help foster empathy, reduce moral distress, and strengthen the quality of the doctor-parent-patient triad.

scholarly journals INFORMED CONSENT IN CLINICAL TRIALS FOR PERSONS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S28-S28 ◽  
Author(s):  
Joan G Carpenter
Keyword(s):  
Clinical Trial ◽  
Decision Making ◽  
Clinical Trials ◽  
Informed Consent ◽  
Nursing Homes ◽  
Decision Maker ◽  
Surrogate Decision Maker ◽  
Decision Making Capacity ◽  
Consent Document ◽  
Surrogate Decision

Abstract Informed consent is one of the most important processes during the implementation of a clinical trial; special attention must be given to meeting the needs of persons with dementia in nursing homes who have impaired decision making capacity. We overcame several challenges during enrollment and consent of potential participants in a pilot clinical trial including: (1) the consent document was designed for legally authorized representatives however some potential participants were capable of making their own decisions; (2) the written document was lengthy yet all seven pages were required by the IRB; (3) the required legal wording was difficult to understand and deterred potential participants; and (4) the primary mode of communication was via phone. We tailored assent and informed consent procedures to persons with dementia and their legally authorized representative/surrogate decision maker to avoid risking an incomplete trial and to improve generalizability of trial results to all persons with dementia.

Ethics

Oncology ◽  
2017 ◽  
pp. 728-738
Author(s):  
Natalia S. Ivascu ◽  
Sheida Tabaie ◽  
Ellen C. Meltzer
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Informed Consent ◽  
Ethical Issues ◽  
Surrogate Decision Making ◽  
Ethical Problems ◽  
Decision Making Capacity ◽  
Surgical Critical Care ◽  
Surrogate Decision ◽  
Special Circumstances

In all areas of medicine physicians are confronted with a myriad ethical problems. It is important that intensivists are well versed on ethical issues that commonly arise in the critical care setting. This chapter will serve to provide a review of common topics, including informed consent, decision-making capacity, and surrogate decision-making. It will also highlight special circumstances related to cardiac surgical critical care, including ethical concerns associated with emerging technologies in cardiac care.

Ethics

2017 ◽  
pp. 1-11
Author(s):  
Natalia S. Ivascu ◽  
Sheida Tabaie ◽  
Ellen C. Meltzer
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Informed Consent ◽  
Ethical Issues ◽  
Surrogate Decision Making ◽  
Ethical Problems ◽  
Decision Making Capacity ◽  
Surgical Critical Care ◽  
Surrogate Decision ◽  
Special Circumstances

In all areas of medicine physicians are confronted with a myriad ethical problems. It is important that intensivists are well versed on ethical issues that commonly arise in the critical care setting. This chapter will serve to provide a review of common topics, including informed consent, decision-making capacity, and surrogate decision-making. It will also highlight special circumstances related to cardiac surgical critical care, including ethical concerns associated with emerging technologies in cardiac care.

Ethics

2015 ◽  
pp. 124-134
Author(s):  
Natalia S. Ivascu ◽  
Sheida Tabaie ◽  
Ellen C. Meltzer
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Informed Consent ◽  
Ethical Issues ◽  
Surrogate Decision Making ◽  
Ethical Problems ◽  
Decision Making Capacity ◽  
Surgical Critical Care ◽  
Surrogate Decision ◽  
Special Circumstances

In all areas of medicine physicians are confronted with a myriad ethical problems. It is important that intensivists are well versed on ethical issues that commonly arise in the critical care setting. This chapter will serve to provide a review of common topics, including informed consent, decision-making capacity, and surrogate decision-making. It will also highlight special circumstances related to cardiac surgical critical care, including ethical concerns associated with emerging technologies in cardiac care.

Advance Care Planning and Surrogate Decision-Making (DRAFT)

2018 ◽  
Author(s):  
Robert C. Macauley
Keyword(s):  
Decision Making ◽  
Decision Maker ◽  
Patient Autonomy ◽  
Best Interests ◽  
Evidence Based ◽  
Surrogate Decision Maker ◽  
Substituted Judgment ◽  
Decision Making Capacity ◽  
Advance Care ◽  
Surrogate Decision

Adult patients are presumed to possess decision-making capacity, but when they are unable to make their own decisions—which is especially frequent in the context of serious illness—ideally a surrogate decision-maker will be able to determine what the patient would have wanted (i.e., substituted judgment). Only when this is not possible is it necessary to fall back on what seems to be in the patient’s best interests. To foster patient autonomy, goals and values should be identified and documented in advance, such as in an advance directive, as well as a surrogate decision-maker named. This helps guide the medical team in critical and often uncertain times, given the challenges in accurate prognostication (which are lessening with the advent of evidence-based tools).

scholarly journals End-of-Life Decisions: A Cross-National Study of Treatment Preference Discussions and Surrogate Decision-Maker Appointments

PLoS ONE ◽  
2013 ◽  
Vol 8 (3) ◽  
pp. e57965 ◽  
Author(s):  
Natalie Evans ◽  
H. Roeline Pasman ◽  
Tomás Vega Alonso ◽  
Lieve Van den Block ◽  
Guido Miccinesi ◽  
...  
Keyword(s):  
End Of Life ◽  
Decision Maker ◽  
Treatment Preference ◽  
National Study ◽  
Surrogate Decision Maker ◽  
End Of Life Decisions ◽  
Life Decisions ◽  
Surrogate Decision ◽  
Cross National Study ◽  
Cross National

Ethics

2011 ◽  
pp. 115-142 ◽  
Author(s):  
Michele J. Karel
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Older Adult ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Detailed Review ◽  
Decision Making Capacity ◽  
Care Systems ◽  
Surrogate Decision ◽  
Fundamental Tension

Chapter 9 has three broad aims. Firstly it provides a detailed review of the foundational competencies for ethical geropsychology practice, including the fundamental tension between the values of respecting the autonomy versus protecting the safety of an older adult; the concept of decision-making capacity; the challenges of surrogate decision making; and legal, clinical, and social tools central to working with vulnerable older adults. It then covers specific ethical issues that can arise in psychological assessment, intervention, consultation, and research with older adults or care systems are identified, followed by a model for ethical decision making in geriatric care.

Sign in / Sign up

Export Citation Format

Share Document