alan h. lockwood, md, faan program director, adult neurology
DESCRIPTION
Ethics in Clinical Medicine View from Neurology Overview End-of-life & life-sustaining decisions Research. Alan H. Lockwood, MD, FAAN Program Director, Adult Neurology. Straightforward Easy to understand (not full of jargon) and fairly short - PowerPoint PPT PresentationTRANSCRIPT
Ethics in Clinical Medicine View from Neurology
OverviewEnd-of-life & life-sustaining decisions
Research
Alan H. Lockwood, MD, FAAN
Program Director, Adult Neurology
• Straightforward• Easy to understand
(not full of jargon) and fairly short
• Ethical principles are parallel to those used in research
• Paperback, relatively inexpensive
• Not based on ACGME core competencies
Overview of Ethical Guidelines
1. Respect for persons1. Avoid deception and non-disclosure
2. Maintain confidentiality
3. Keep promises (don’t make promises you can’t keep!)
2. Beneficence (act in best interest of patient)1. Unwise decisions by patients (duty to listen,
educate, persuade, compromise): patient’s informed decision prevails
2. Conflicts of interest
Overview --- cont3. Allocate resources justly
4. Use ethical guidelines1. Interpret in context of specific case
2. Exceptions may be appropriate
3. Different guidelines may conflict
5. Principles, rules1. Principle = basis for reasoning or a guide for
conduct of procedure
2. Rule = defines conduct, binding
Overview --- cont
5. Principles, rules, duties (cont)2. Rules: generalizations that are narrower
than principles, binding, prohibit specific behaviors, e.g., obtain informed consent prior to surgery
3. Duties: Lo avoids this term, may connote legal as well as ethical obligation (we will try to get to this with discussion of specific cases, e.g., Quinlan, Cruzan, Schiavo, Tarasoff)
Approach to Ethical Dilemmas
Gather informationWhat is the clinical situation?Who is the primary decision-maker?What are the views of the healthcare team and
stakeholders?
Clarify ethical issuesWhat are the pertinent ethical issues and
conflicts?Understand best thinking on the issues
Approach ---- cont
Resolve the dilemmasWhat pragmatic issues complicate case
Hold team meeting
Meet with patient or family or both
Deal with psychosocial issues directly
Ask for help if needed
End-of-Life andLife-Sustaining Decisions
• What is your own personal experience? Have you confronted this dilemma?
• What are your own values that you would invoke in assisting patients and their families in making these decisions?
• What conflicts do you foresee that may arise with regard to your personal values and possible requests by patients or their surrogates?
• How would you deal with these conflicts?
Milestones
• Pure Food and Drug Act (1906)• Nuremberg Code (1948)• National Research Act of 1974 and
Belmont Report – Respect for Persons, Beneficence, Justice
• Declaration of Helsinki (World Medical Assn)
• Common Rule (Applies to US funded studies)
Case Studies
• Tuskegee Syphilis Study (1932 – 1972).• Jesse Gelsinger Case: gene therapy• Hopkins Asthma: death of participant, use
of chemical that was not approved drug, no IND
• Rochester Bronchoscopy case, death of participant from lidocaine
Children’s Environmental Exposure Research Study (CHEERS)
“The purpose of the study is to learn about levels of pesticides and common household chemicals in homes of young children.”
“Collection of accurate micro-environment and macroactivity information for children under the age of 3 years is essential to reduce the default assumptions that are currently being used for quantifying risk.”
Ethics in Public Health ResearchAmerican Journal of Public Health
Human Testing of Pesticides: Ethical and Scientific Considerations.
2004;94:1908-1916