Ethical dilemmas for physicians in time of war.

During times of war, physicians are sometimes faced with the conflict of their professional duties to ensure the ethical principles of beneficence, non-maleficence, patient autonomy, and self-determination, within the framework of the proper ethical conduct in the practice of medicine, and the obligation and duties placed upon the physician by the state in times of war. Many ethical dilemmas may occur for the physician on the battlefield or elsewhere in the war region, including the treatment of detainees and the priority of treating wounded enemy soldiers or civilians first. When physicians are faced with a conflict between following state or national policies and following international principles of humanitarian law and medical ethics, the physician should opt for the latter.

Fluids and nutrition: perspectives from Jewish Law (Halachah).

Purpose: The use of nutrition and hydration in the terminally ill had been considered normal supportive measures until recently. Currently, many institutions, health care personnel and family members hold that nutrition and hydration are extraordinary measures that may be terminated.

Methods: A case is offered to discuss the ruling by traditional Jewish law (Halachah) on the issue of nutrition and hydration.

Intramuscular bleeding as a complication of anticoagulation treatment in a patient with systemic lupus erythematosus and antiphospholipid syndrome.

Thrombotic events account for significant morbidity and mortality among patients with antiphospholipid syndrome. The cornerstone of management includes long-term anticoagulation. However, the benefit of long-term anticoagulation must be weighed against the risk of bleeding complications.

Patient noncompliance: causes and solutions.

This essay examines the subject of patient noncompliance with prescribed medications or other health regimens and its possible causes, and discusses possible solutions. Noncompliance or nonadherence to prescribed medical regimens may have serious detrimental effects on the patient's health and quality of life, and may lead to further morbidity or mortality. Proposed solutions to the problem of noncompliance are many (Table 3).

Medical confidentiality and patient privacy: the Jewish perspective.

This article presents the approach of Jewish law to the major issue of medical confidentiality and patient privacy. For an extensive discussion of Jewish medical ethics and an in-depth presentation of the Jewish view of 39 major issues in medical ethics, the reader is referred elsewhere [15]. Briefly, the Jewish view toward medical ethical subjects is predicated on the general principle of the supreme value of human life.

Informing the patient about a fatal disease: from paternalism to autonomy--the Jewish view.

Until the late 20th century, withholding a fatal diagnosis functioned as a paradigm for sharing other medical information with patients. The obligation of confidentiality was emphasized and disclosure was ignored. Ethicists perceived the doctor-patient relationship as oriented to therapy, reassurance, and avoiding harm.

Allocation or misallocation of limited medical resources.

Very small premature babies are now kept in neonatal intensive care units for many months to give them a chance at near normal life, but at a cost of up to dollars 1 million. Is that a proper allocation of our finite medical resources (personnel, equipment, supplies, and other necessities) for premies? Or is such action a misallocation of these resources? Both sides of the argument have positive and negative merit. A final philosophical statement is that each human created in the image of God has supreme value.

Ethics of practicing medical procedures on newly dead and nearly dead patients.

Objective: To examine the ethical issues raised by physicians performing, for skill development, medically nonindicated invasive medical procedures on newly dead and dying patients.

Design: Literature review; issue analysis employing current normative ethical obligations, and evaluation against moral rules and utilitarian assessments manifest in other common perimortem practices.

Results: Practicing medical procedures for training purposes is not uncommon among physicians in training.

Medicine on the internet: Jewish perspectives.

The ethical principles of beneficence and non-maleficence are deeply rooted in Judaism. A physician is obligated to heal and is given Divine license to do so. A patient is also obligated to seek healing.

Catamenial hemoptysis and pulmonary endometriosis: a case report.

Hemoptysis can be caused by a variety of pulmonary diseases, including parasitic infections, tuberculosis, chronic bronchitis and malignancies. Rarely, pulmonary endometriosis can present with hemoptysis and pose a diagnostic problem to clinicians. Pulmonary endometriosis can easily be confused with other clinical entities, including pulmonary embolism, pneumonia and pneumothorax.

Myocardial infarction in sickle cell disease.

Vasculo-occlusive crisis with organ infarctions occur in sickle cell disease (SCD). However, heart infarction is not commonly reported. We reviewed 19 cases of documented myocardial infarction (MI) in SCD patients.

ANCA-associated small-vessel vasculitis.

Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis is the most common primary systemic small-vessel vasculitis to occur in adults. Although the etiology is not always known, the incidence of vasculitis is increasing, and the diagnosis and management of patients may be challenging because of its relative infrequency, changing nomenclature, and variability of clinical expression. Advances in clinical management have been achieved during the past few years, and many ongoing studies are pending.