Ethics

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.

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Ethics

Advances in Medical Technologies and Clinical Practice - Modern Concepts and Practices in Cardiothoracic Critical Care ◽

10.4018/978-1-4666-8603-8.ch006 ◽

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.

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INFORMED CONSENT IN CLINICAL TRIALS FOR PERSONS WITH DEMENTIA

Innovation in Aging ◽

10.1093/geroni/igz038.106 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S28-S28 ◽

Cited By ~ 1

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.

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AMA Code of Medical Ethics' Opinions on Patient Decision-Making Capacity and Competence and Surrogate Decision Making

The AMA Journal of Ethic ◽

10.1001/journalofethics.2017.19.7.coet1-1707 ◽

2017 ◽

Vol 19 (7) ◽

pp. 675-677

Keyword(s):

Decision Making ◽

Medical Ethics ◽

Surrogate Decision Making ◽

Patient Decision Making ◽

Patient Decision ◽

Decision Making Capacity ◽

Surrogate Decision

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Surrogate decision making of chemotherapy consent: do we really provide informed consent of chemotherapy for patients?

The Korean Journal of Internal Medicine ◽

10.3904/kjim.2017.252 ◽

2019 ◽

Vol 34 (3) ◽

pp. 626-633

Author(s):

Jung Hye Kwon ◽

Sun Kyung Baek ◽

Bong-Seog Kim ◽

Su-Jin Koh ◽

Hee Kyung Ahn ◽

...

Keyword(s):

Decision Making ◽

Informed Consent ◽

Surrogate Decision Making ◽

Surrogate Decision

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Ethical Issues in Surgery

10.2310/vasc.2241 ◽

2015 ◽

Author(s):

Ira J. Kodner ◽

Mary E. Klingensmith ◽

Jason D. Keune

Keyword(s):

Ethical Issues ◽

Conflicts Of Interest ◽

Surrogate Decision Making ◽

Do Not Resuscitate ◽

Surgical Innovation ◽

Ethical Problems ◽

Respect For Autonomy ◽

Surgical Ethics ◽

Do Not Resuscitate Orders ◽

Surrogate Decision

To be a good surgeon, one must be technically good and scientifically sound, but also ethical to the degree that has traditionally been demanded by our profession. In this chapter, the authors discuss what ethical problems in surgery are and how they might be approached. Respect for autonomy, nonmaleficence, beneficence, and justice define Principlism that forms the backbone of most discourse in clinical medical ethics. Consequentialism/utilitarianism, deontology, virtue ethics, “ethics of care”, and casuistry are all covered. The authors then scrutinize several contemporary problems in surgical ethics. Described and discussed in depth are issues associated with the ‘end of life’; surrogate decision making, futility, “do not resuscitate” orders in the operating room, conflicts of interest, industry payments, and surgical innovation, informed consent, and refusal of care. This review is not meant to be an exhaustive treatment of surgical ethics but a survey highlighting the most common ethical problems. This review contains 2 figures, 3 tables, and 61 references.

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Families' Thoughts Regarding Surrogate Decision-Making and Nursing Support in Critical Care.

Journal of Japan Academy of Critical Care Nursing ◽

10.11153/jaccn.11.3_11 ◽

2015 ◽

Vol 11 (3) ◽

pp. 11-23 ◽

Cited By ~ 1

Author(s):

Kazumi Ishizuka ◽

Tomoko Inoue

Keyword(s):

Decision Making ◽

Critical Care ◽

Surrogate Decision Making ◽

Nursing Support ◽

Surrogate Decision

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Psychiatric research

Psychiatric Ethics ◽

10.1093/med/9780198839262.003.0015 ◽

2021 ◽

pp. 351-380

Author(s):

Laura B. Dunn ◽

Laura Weiss Roberts

Keyword(s):

Decision Making ◽

At Risk ◽

Informed Consent ◽

Mental Disorders ◽

Ethical Issues ◽

Psychiatric Research ◽

Substantial Body ◽

Decision Making Capacity ◽

Human Volunteers ◽

Potential Sources

The ethical engagement of human volunteers is critical to advancing research on mental disorders. The symptoms and impairments commonly associated with psychiatric disorders nevertheless raise numerous issues about the ethical dimensions of research involving people at risk for, living with, and suffering from these disorders. A substantial body of literature now exists addressing both conceptual and empirical issues related to ethical dimensions of psychiatric research. While much of the discussion of ethical issues in research has focused on informed consent and decision-making capacity, additional relevant issues also warrant consideration. These include influences on participants’ decisions about enrolling in research, potential sources of vulnerability, and investigator integrity. This chapter provides an overview of these topics, describes two frameworks for analysing the ethical dimensions of research, and utilizes case illustrations to highlight some of these issues.

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Ethical Issues in Surgery

DeckerMed Surgery ◽

10.2310/surg.2241 ◽

2013 ◽

Author(s):

Ira J. Kodner ◽

Mary E. Klingensmith ◽

Jason D. Keune

Keyword(s):

Ethical Issues ◽

Conflicts Of Interest ◽

Surrogate Decision Making ◽

Do Not Resuscitate ◽

Surgical Innovation ◽

Ethical Problems ◽

Respect For Autonomy ◽

Surgical Ethics ◽

Do Not Resuscitate Orders ◽

Surrogate Decision

To be a good surgeon, one must be technically good and scientifically sound, but also ethical to the degree that has traditionally been demanded by our profession. In this chapter, the authors discuss what ethical problems in surgery are and how they might be approached. Respect for autonomy, nonmaleficence, beneficence, and justice define Principlism that forms the backbone of most discourse in clinical medical ethics. Consequentialism/utilitarianism, deontology, virtue ethics, “ethics of care”, and casuistry are all covered. The authors then scrutinize several contemporary problems in surgical ethics. Described and discussed in depth are issues associated with the ‘end of life’; surrogate decision making, futility, “do not resuscitate” orders in the operating room, conflicts of interest, industry payments, and surgical innovation, informed consent, and refusal of care. This review is not meant to be an exhaustive treatment of surgical ethics but a survey highlighting the most common ethical problems. This review contains 2 figures, 3 tables, and 61 references.

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Determining medical decision-making capacity in brain tumor patients: why and how?

Neuro-Oncology Practice ◽

10.1093/nop/npaa040 ◽

2020 ◽

Vol 7 (6) ◽

pp. 599-612 ◽

Cited By ~ 1

Author(s):

Andrea Pace ◽

Johan A F Koekkoek ◽

Martin J van den Bent ◽

Helen J Bulbeck ◽

Jane Fleming ◽

...

Keyword(s):

Decision Making ◽

Brain Tumor ◽

Medical Decision Making ◽

Clinical Decision Making ◽

Best Interests ◽

Medical Decision ◽

Surrogate Decision Making ◽

Tumor Patients ◽

Decision Making Capacity ◽

Surrogate Decision

Abstract Background Brain tumor patients are at high risk of impaired medical decision-making capacity (MDC), which can be ethically challenging because it limits their ability to give informed consent to medical treatments or participation in research. The European Association of Neuro-Oncology Palliative Care Multidisciplinary Task Force performed a systematic review to identify relevant evidence with respect to MDC that could be used to give recommendations on how to cope with reduced MDC in brain tumor patients. Methods A literature search in several electronic databases was conducted up to September 2019, including studies with brain tumor and other neurological patients. Information related to the following topics was extracted: tools to measure MDC, consent to treatment or research, predictive patient- and treatment-related factors, surrogate decision making, and interventions to improve MDC. Results A total of 138 articles were deemed eligible. Several structured capacity-assessment instruments are available to aid clinical decision making. These instruments revealed a high incidence of impaired MDC both in brain tumors and other neurological diseases for treatment- and research-related decisions. Incapacity appeared to be mostly determined by the level of cognitive impairment. Surrogate decision making should be considered in case a patient lacks capacity, ensuring that the patient’s “best interests” and wishes are guaranteed. Several methods are available that may help to enhance patients’ consent capacity. Conclusions Clinical recommendations on how to detect and manage reduced MDC in brain tumor patients were formulated, reflecting among others the timing of MDC assessments, methods to enhance patients’ consent capacity, and alternative procedures, including surrogate consent.

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