The effect of patients' noncompliance on their surgeons' obligations.

Effective physicians recognize that most patients have difficulty following instructions for a variety of reasons. That difficulty is best understood as nonadherence rather than noncompliance. The surgeon's role is to make the patient's choice informed, to be aware of the risk factors for nonadherence, and not to make adherence any more difficult than it has to be.

Should rapid tests for HIV infection now be mandatory during pregnancy? Global differences in scarcity and a dilemma of technological advance.

Since testing for HIV infection became possible in 1985, testing of pregnant women has been conducted primarily on a voluntary, 'opt-in' basis. Faden, Geller and Powers, Bayer, Wilfert, and McKenna, among others, have suggested that with the development of more reliable testing and more effective therapy to reduce maternal-fetal transmission, testing should become either routine with 'opt-out' provisions or mandatory. We ask, in the light of the new rapid tests for HIV, such as OraQuick, and the development of antiretroviral treatment that can reduce maternal-fetal transmission rates to <2%, whether that time is now.

The effect of patients' noncompliance on their surgeons' obligations.

Professional oaths and codes do not establish a firm basis for the obligation to treat all patients and they provide little or no clear guidance about whether patient nonadherence exempts a physician from a longstanding and still prevalent tradition in surgery supports a strong obligation to one's established patients. A personal belief in an obligation to serve those less fortunate or even less compliant could support sustained treatment and special assistance to a nonadherent patient. A collective, professional, objective, informed decision to exclude a patient who is highly likely to be nonadherent or incapable of adherence from the benefit of a scarce resource, such as a human organ, is defensible and appropriate.

How infectious diseases got left out--and what this omission might have meant for bioethics.

In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as autonomy and the harm principle, to infectious examples.

Electronic screening of dictated reports to identify patients with do-not-resuscitate status.

Objective: Do-not-resuscitate (DNR) orders and advance directives are increasingly prevalent and may affect medical interventions and outcomes. Simple, automated techniques to identify patients with DNR orders do not currently exist but could help avoid costly and time-consuming chart review. This study hypothesized that a decision to withhold cardiopulmonary resuscitation would be included in a patient's dictated reports.

Are there characteristics of infectious diseases that raise special ethical issues?

This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases' powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on humans by foreign micro-organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases.