The bioethically constructed ideal dying patient in USA

Using research data collected from terminally ill cancer patients and their family members in four ethnic groups living in a west coast city of the USA, this paper describes the concept of the ideal dying patient. This concept, constructed by the health professionals giving care to these patients, has implications for nursing ethics in a multi-cultural society as well as in cross cultural ethics research.     

Perceptions and practices of medical practitioners towards ethics in medical practice – A study from coastal South India

Ethics is the application of values and moral rules to human activities. Medical practitioners are expected to not only have the skills and knowledge relevant to their field but also with the ethical and legal expectations that arise out of the standard practices. The present research was conducted with an aim to study the perceptions and practices of medical practitioners towards healthcare ethics in Indian scenario and to strengthen the evidence in the field of ethics training. A cross-sectional study was carried out in three associate hospitals of a Medical College in Southern India. Medical practitioners included in the study were administered a pre-tested, semi-structured questionnaire. Data was collected based on their responses on a 5 point Likert scale and analyzed using SPSS version 11.5. The majority of the participants mentioned that their perceptions of ethics in medical practice were based on information obtained during their undergraduate training, followed by experience at work. The medical practitioners had a positive perception on issues relating to consent in medical practice. However, the same degree of perception was not observed for issues related to confidentiality and their dealing with patients during emergency conditions. The majority of the medical practitioners agreed that ethical conduct is important to avoid legal and disciplinary actions. Among the medical practitioners, the responses of specialists and non-specialists were mostly similar with major differences of opinion for a few issues. A highest level of knowledge, awareness and understanding of ethics are expected in medical practice as it is the foundation of sound healthcare delivery system.     

Prevention of violence in prison – The role of health care professionals

The World Health Organization (WHO) classifies violence prevention as a public health priority. In custodial settings, where violence is problematic, administrators and custodial officials are usually tasked with the duty of addressing this complicated issue-leaving health care professionals largely out of a discussion and problem-solving process that should ideally be multidisciplinary in approach.Health care professionals who care for prisoners are in a unique position to help identify and prevent violence, given their knowledge about health and violence, and because of the impartial position they must sustain in the prison environment in upholding professional ethics. Thus, health care professionals working in prisons should be charged with leading violence prevention efforts in custodial settings.In addition to screening for violence and detecting violent events upon prison admission, health care professionals in prison must work towards uniform in-house procedures for longitudinal and systemized medical recording/documentation of violence. These efforts will benefit the future planning, implementation, and evaluation of focused strategies for violence prevention in prisoner populations.     

How teaching on the care of the victim of sexual violence alters undergraduate medical students' awareness of the key issues involved in patient care and their attitudes to such patients

Sexual violence is known to be highly prevalent, albeit the majority of incidents are not reported to the authorities. It is therefore likely that medical students will encounter very many patients who have experienced sexual violence during their postgraduate careers, although this history may never be disclosed to them. Numerous highly regarded sources have advocated for the inclusion of instruction on the care of the victim of sexual violence in undergraduate medical curricula. Moreover, there has been a call for research to measure the effectiveness of educational strategies addressing the issue of sexual violence at undergraduate level. We present an evaluation of the effectiveness of a reproducible teaching session on care of the victim of sexual violence appropriate for undergraduate medical students, looking specifically at alterations in students' awareness of the key issues involved in patient care and their attitudes to such patients. This research demonstrates that such an educational intervention significantly enhances undergraduate medical students' awareness of the issues involved in patient care and their insight in to myths surrounding sexual violence.     

Complex Billing for Nonemergency Outpatient Imaging: An Obstacle to the Success of Health Care Price Transparency Initiatives

PurposeRecent price transparency initiatives have considerable limitations, notably due to the complexity of health care products. A single care encounter often consists of several services that may be performed by numerous clinicians and health care facilities that bill independently. The objective of this study was to describe the complexity in billing for nonemergency, noninvasive outpatient imaging and its variation across care delivery settings and imaging modalities.MethodsUsing billing records from the 2019 IBM MarketScan Commercial Database, the authors examined the number of billing entities involved in outpatient imaging encounters and the sets of relevant items and services for which patients were billed.ResultsIn total, 5,210,129 imaging encounters were analyzed. Patients received bills from multiple billing entities for 70.9% of hospital-based encounters, 4.5% of office-based encounters, and 7.6% of encounters at imaging centers. Contrast agent was billed separately from the imaging procedures in 55.9%, 71.5%, and 55.3% of encounters for contrast imaging at hospitals, offices, and imaging centers, respectively. Billing for other ancillary items and services (facility fees, 3-D reconstruction, anesthesia and sedation) was relatively rare.ConclusionsTwo key aspects of billing complexity may make obtaining complete and reliable price estimates before receiving outpatient imaging difficult for patients: the number of billing entities involved in care delivery and billing for fees and ancillary services beyond the primary imaging procedure. Given that price transparency initiatives are aimed primarily at helping patients anticipate the total cost of their care, policymakers, payers, and providers should take additional steps to provide patients with reliable information on the prices of entire care experiences.     

Addressing ethical issues in geriatrics and long-term care: ethics education at the Baycrest Centre for Geriatric Care

An innovative program in ethics education exists at Baycrest Centre for Geriatric Care. This program can serve as a helpful model for long-term care and geriatric care facilities seeking to implement formal training programs in bioethics. Various aspects of the ethics education program are examined. In addition to describing the role of the ethics committee and research ethics board, consideration is given to case consultations, ethics rounds, the training of junior physicians and medical students, grand rounds and the planning of conferences and guest lectures. With regard to educational content in bioethics, health law, professional guidelines and the principlist approach of Beauchamp and Childress are used to explore the ethical dimensions of particular cases. Given the clinical context of the educational initiatives, the pedagogical approach is predominately case-based. While the bioethics literature emphasizes the patient-physician relationship, ethics education at Baycrest recognizes the importance of multiple professions. Physicians, nurses, social workers, speech pathologists, nutritionists and other health care providers are involved in ethical deliberation and education.     

The use of interpreters in medical settings and forensic medical examinations in Australia: The relationship between medicine and linguistics

Medical examinations are dependent on combining communication with professional competence. In the development of a global multicultural community with the use of multiple languages, doctors have become increasingly dependent on language facilitation such as interpreting and translation. Despite professional studies, the use of language facilitation with its associated problems has not been fully explored in graduate and post-graduate medical and forensic medical training. There may still be some lack of reciprocal understanding between the medical and linguistic fields, their ethics, obligations and limits although both fields and their ethical frameworks are closer related than might be expected. This article is a discussion that aims at providing a basic understanding of guidelines as to the origin and appropriate use of language interpretation in medical and forensic medical examinations.     

Ethical misconduct by abuse of conscientious objection laws

This paper addresses laws and practices urged by conservative religious organizations that invoke conscientious objection in order to deny patients access to lawful procedures. Many are reproductive health services, such as contraception, sterilization and abortion, on which women's health depends. Religious institutions that historically served a mission to provide healthcare are now perverting this commitment in order to deny care. Physicians who followed their calling honourably in a spirit of self-sacrifice are being urged to sacrifice patients' interests to promote their own, compromising their professional ethics by conflict of interest. The shield tolerant societies allowed to protect religious conscience is abused by religiously-influenced agencies that beat it into a sword to compel patients, particularly women, to comply with religious values they do not share. This is unethical unless accompanied by objectors' duty of referral to non-objecting practitioners, and governmental responsibility to ensure supply of and patients' access to such practitioners.     

地震伤员转运救援影响因素分析

目的 分析汶川地震伤员转运医疗救援中的影响因素. 方法 借助第三军医大学附属西南医院院前急救预案配置协调指挥人员、受过心理专业培训的急救专科医护人员和后勤保障人员进行转运伤员以及途中早期施行全程心理疏导. 结果 汶川地震伤员转运救援中,我院救援队员借助院前急救预案、专用器材库支持、整体救援模式和对伤员施行心理疏导,成功转运162例伤员. 结论 本次转运救援模式运行与途中心理救援实践提示,后方医院应建立应对特大灾害伤员心理应激的救援体制,建立健全应对特大灾害远程前接转运救援预案,完善与稳定应对特人灾害批苗伤员远程救援的专业医疗队伍以及建立和完善远程转运的专用医疗物资器材库.     

Ethics in Radiology: Wait Lists Queue Jumping

Education in ethics is a requirement for all Royal College residency training programs as laid out in the General Standards of Accreditation for residency programs in Canada. The ethical challenges that face radiologists in clinical practice are often different from those that face other physicians, because the nature of the physician-patient interaction is unlike that of many other specialties. Ethics education for radiologists and radiology residents will benefit from the development of teaching materials and resources that focus on the issues that are specific to the specialty. This article is intended to serve as an educational resource for radiology training programs to facilitate teaching ethics to residents and also as a continuing medical education resource for practicing radiologists. In an environment of limited health care resources, radiologists are frequently asked to expedite imaging studies for patients and, in some respects, act as gatekeepers for specialty care. The issues of wait lists, queue jumping, and balancing the needs of individuals and society are explored from the perspective of a radiologist.     

Basic care, bodily knowledge and feminist ethics

Within medical schools and within research concerning the ethical questions of health care, basic care and its allied participants have not been stressed enough. The aim of this paper is to emphasise the practice of basic care and some moral problems in connection to this practice. Basic care is the care-provider's providing assistance for patients with bodily dysfunction. The relationships between patient and care-provider in basic care have many substantial similarities with other close social relationships. Thus, the interactive relationships in basic care are an important matter of public concern. Seen from an ethical perspective, its significance due to the welfare-aspects of society is obvious. Patients and professionals in basic care have together a unique knowledge about the meaning of being. Ethics is much more than following theories, rules, and principles and this article presents an alternative to the dominant approaches of health care ethics.     

The ethics of medicine vs. the ethos of Wall Street.

In this first article in a two-part series, Contributing Editor Stephen J. Hage examines how the business of health care delivery and financing interfaces with the practice of medicine. He argues that the result is often a struggle between the ethics of providing care versus the ethos of doing business. He traces business's longstanding involvement in health care, the success of delivery alternatives like HMOs, and other issues. In the second article in this series, to be published in the Summer/July issue of Radiology Management, Mr. Hage will offer recommendations for dealing with the ethics versus ethos dilemma.     

The ethics of medicine vs. the ethos of Wall Street (Part II).

This is the second article in a two-part series by Contributing Editor Stephen J. Hage. In Part I, Mr. Hage examined how the business of health care delivery and financing interfaces with the practice of medicine. He argued that the result is often a struggle between the ethics of providing care versus the ethos of doing business. In Part II, he traces the role business has played and responsibility it must assume for shaping our contemporary health care system. He ends by offering specific recommendations for dealing with the ethics versus ethos dilemma.     

The Role of the Family Physician in Sports Medicine

In brief: Sports medicine is often considered an orthopedic subspecialty, but family physicians represent the grass roots of athletic care. Millions of competitive and recreational athletes from all age-groups turn to family physicians with their sports-related problems. In this round-table discussion we asked four physicians to talk about the role of the family practitioner in providing comprehensive care, prescribing exercise, and functioning as team physician and educator. They also discuss ethics, the preparticipation screening exam, sources of sports medicine information, and a sports medicine curriculum.     

Perceptions of Ethics in Interventional Radiology

PurposeTo characterize perceptions of ethics among interventional radiologists to guide the development of an applied, specialty-specific approach to ethics.Materials and MethodsA 17-question survey on perceptions of ethics and use of ethics resources was developed and vetted via cognitive interviewing of 15 diverse, representative members of the target population. The survey was distributed via the Society of Interventional Radiology, receiving 685 responses (48% participation and 90% completion rates). Responses were compared between different demographics, and common themes from free text responses were identified via content analysis.ResultsMost respondents indicated ethics is important for IR (93%) and more focus on practical approaches to ethical issues is needed (73%). Various ethical issues were perceived to be important for IR, but differentiating palliative from futile care was ranked as the top ethical issue. Trainees had more ethics training (P=0.05) but less confidence in navigating ethical issues (P<0.01). Regardless of career stage, those with ethics training (44%) were more confident in navigating ethical issues (P<0.01). Use of resources such as information sheets for patients and resources for coping with complications were variable and limited by lack of availability or knowledge of such resources in IR.ConclusionsInterventional radiologists believe ethics is important and face diverse ethical issues, but they are challenged by variable experiences and access to practical tools to navigate these challenges.     

Honorary Coauthorship: Does It Matter?

Objective

To examine the perception of honorary coauthorship among medical academics and to determine whether a potential effect of honorary coauthorship exists on patient care.

Methods

Corresponding authors of every fourth primary research paper published in JAMA, Journal of the American Medical Association (2001−2003), Canadian Medical Association Journal (2001−2003), British Medical Journal (1998−2000), and Lancet (1998−2000) were surveyed electronically. Questions were focused on each author's personal experience and perception of honorary coauthorship.

Results

Sixty-five percent of corresponding authors responded (127/195). Fifty-five percent of respondents had published more than 50 peer-reviewed journal articles, and 52% had been listed with an honorary coauthor at some point in their career. Eighteen percent of respondents had been required at some point to list authors who had provided data via a commercial relationship. A majority of authors believed that there were potential negative effects of honorary coauthorship for both the authors themselves (73%) and for their coauthors (83%). These negative effects included personal liability for honorary authors (29%) and dilution of relative contribution for their coauthors (54%). Sixty-two percent of respondents said that honorary coauthorship may have a negative effect on patient care; however, only 2% had been involved in a case in which this phenomenon had actually occurred.

Conclusion

Honorary coauthorship remains prevalent in the medical literature, even among highly published authors, and has the potential to negatively affect patient care. Respondents believed that a number of possible negative consequences of this phenomenon exist for honorary authors, their coauthors, and patients. Efforts to understand the true influence of honorary authorship on patient care may help further curb this practice in the literature.     

Turf wars in radiology: the overutilization of imaging resulting from self-referral

A recent report by the Medicare Payment Advisory Commission to Congress indicated that the utilization of diagnostic imaging is growing more rapidly than that of any other type of physician service. This has engendered concern among those who pay for health care. In this article, the authors review the role of self-referral in driving up imaging utilization.A number of studies of the self-referral factor in imaging have been conducted over the past three decades. These have consistently shown that when nonradiologist physicians operate their own imaging equipment and have the opportunity to self-refer, their utilization is substantially higher than among other physicians who refer their patients to radiologists. It has also been shown that the vast bulk of the recent increases in imaging utilization are attributable to nonradiologists who self-refer. The authors estimate that the cost to the American health care system of unnecessary imaging resulting from self-referral by nonradiologists is $16 billion per year.     

Ethical issues in health care institutions. Lesson 2: Ethical considerations in group decision making and groupthink

In this second lesson of a five-part WMU/AHRA magazine course on ethics, Dr. Alie tackles an interesting concept--group-think. According to the author, this tendency occurs when cohesive groups lose their ability to critically evaluate alternatives in problem solving. Since groups such as committees or task forces frequently resolve issues and make policy in health care organizations, warning signs of this phenomenon are detailed as well as suggestions to help avoid the problem.     

A code of ethics for the medical dosimetrist - The American Association of Medical Dosimetrists Experience

The Committee on Protocol and Ethics of the American Assoclation of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.     

Bioethical conflicts between Muslim patients and German physicians and the principles of biomedical ethics

In the age of globalisation, more and more people who are members of different religions and cultures live in the same society. This situation tends to create many conflicts in different areas of life and not least in the health care system, a fact which raises a number of bioethical issues. The cultural and religious differences between patient and physician can be a cause of bioethical conflicts and therefore represent a challenge for biomedical ethics. The confrontation between Turkish Muslin patients and the German health care system is a convenient example of this situation. The Muslim Turks came to Germany 40 years ago as industrial workers. Their value system had been shaped by traditional and Islamic parameters in Turkey. With this value system, they now found themselves in the German modern health care system. In many fields of modern medicine there are areas of potential conflict of values, where a Muslin patient will argue differently from a secular or Christian person. In an ethical conflict between two individuals who are members of different cultures, it is necessary to make sure that the ethical concept which is to be used for resolving the problem is relevant. In this particular case, both the Islamic legal responses (fatwa) and the classical theories of biomedical ethics are often insufficient. This paper tries to give a brief outline of these bioethical conflicts and discuss these conflicts with regard to the principle of respect for autonomy in the concept of "principilism," as introduced by T.L. Beauchamp and J.F. Childress. The central question is whether this bioethical concept is able to analyse and to help solve the kinds of ethical conflicts which involve transcultural dimensions. This question is discussed with some consideration of the ongoing debate about universalism versus relativism in biomedical ethics.