Ethical considerations in first-trimester Down syndrome risk assessment.

Purpose Of Review: First-trimester risk assessment has now become sophisticated and of increasing relevance and applicability to decision-making by pregnant woman about invasive diagnosis. Ethics is an essential dimension of understanding this relevance and applicability. This paper addresses the ethical dimensions of first-trimester risk assessment for trisomy 21.

Reforming medical education in ethics and humanities by finding common ground with Abraham Flexner.

Abraham Flexner was commissioned by the Carnegie Foundation for the Advancement of Teaching to conduct the 1910 survey of all U.S. and Canadian medical schools because medical education was perceived to lack rigor and strong learning environments.

La frontera: responsibly managing borders and boundaries in clinical ethics.

The papers in the 2010 "Clinical Ethics" number of the Journal of Medicine and Philosophy explore issues along La Frontera, the borders and boundaries of clinical ethics. The first three papers in this "Clinical Ethics" number of the Journal explore borders and boundaries drawn within clinical ethics, concerning the moral standing of complementary and alternative medicine, palliative sedation, and induced abortion and feticide. The fourth and fifth papers explore the borders and boundaries between research ethics and clinical ethics.

Conflict of credentialing: accolade or unfair trade.

The newly appointed chief of surgery at an open-staff hospital received an application for vascular privileges from a senior general surgeon who took a period of additional fellowship in vascular surgery at a nonacademic regional medical center. The fellowship does not make him board eligible in vascular surgery, but he has maintained his general surgery board certification and the pertinent bylaws do not specifically state which certification is required, only that the surgeon must be board certified and have additional training in vascular surgery. He is a member of a large politically powerful group practice that apparently wants to refer their substantial number of vascular cases internally.

Improving obstetric estimation of outcomes of extremely premature neonates: an evolving challenge.

Aims: A clinically useful website at the US National Institutes of Child Health and Human Development (NICHD) uses an algorithm based on a recent publication to estimate peri-viable neonatal outcomes. This algorithm uses gestational age, ultrasound estimated fetal weight (EFW), fetal sex, and the use of antenatal corticosteroids as the basis for estimation of outcomes and when used after birth is superior to such estimation by gestational age alone. Because one might be tempted to use this algorithm with obstetric patients, we tested its clinical applicability.

The physician's professional role in end-of-life decision-making: voices of racially and ethnically diverse physicians.

Objective: Previous studies have shown racial/ethnic differences in preferences for end-of-life (EOL) care. We aimed to describe values and beliefs guiding physicians' EOL decision-making and explore the relationship between physicians' race/ethnicity and their decision-making.

Methods: Seven focus groups (3 Caucasian, 2 African American, 2 Hispanic) with internists and subspecialists (n=26) were conducted.

Ethics of research in perinatal medicine.

Ethics is an essential component of fetal research. From definitions of medical ethics and the ethical principles of beneficence and respect for autonomy, we identify the ethical concept of the fetus as a patient. We then identify major components of research ethics.

Improving handoffs in the emergency department.

Patient handoffs at shift change are a ubiquitous and potentially hazardous process in emergency care. As crowding and lengthy evaluations become the standard for an increasing proportion of emergency departments (EDs), the number of patients handed off will likely increase. It is critical now more than ever before to ensure that handoffs supply valid and useful shared understandings between providers at transitions of care.

An ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide.

We provide comprehensive, practical guidance for physicians on when to offer, recommend, perform, and refer patients for induced abortion and feticide. We precisely define terminology and articulate an ethical framework based on respecting the autonomy of the pregnant woman, the fetus as a patient, and the individual conscience of the physician. We elucidate autonomy-based and beneficence-based obligations and distinguish professional conscience from individual conscience.

Women and children first: transforming a historic defining moment into a contemporary ethical imperative.

"Women and children first" is a familiar phrase and comes down to us from the heroic sacrifice of their lives by British soldiers on the HMS Birkenhead in 1852. "Women and children first," the New York Declaration of the International Academy of Perinatal Medicine, has defined biases in the allocation of health care resources for women and children in the developing world. In this clinical opinion, we identify challenges to the just allocation of resources for fetal, neonatal, and pregnant patients and provide ethically appropriate responses to these challenges.

When should psychiatrists seek criminal prosecution of assaultive psychiatric inpatients?

This Open Forum commentary reviews the ethical considerations relevant to the question of prosecuting assaultive psychiatric patients, with particular attention to the significance that should be attached to the arguments generated by those considerations. A comprehensive literature search was conducted incorporating the terms "assaultive patients," "ethics," "psychiatric inpatients," and "law." The literature of professional medical ethics was applied to identify relevant domains of ethical argument.

Where to declare poor nursing home care.

You have been called to the emergency room to evaluate an elderly nursing home patient sent for consultation who has ischemic gangrene of the right foot. The patient has vasculopathy, has diabetes, and suffers from moderately advanced dementia. The leg ischemia has been severe and the patient had complained repeatedly but was largely ignored.

Ethics of fetal surgery.

This article provides a comprehensive approach to the ethics of clinical investigation of fetal surgery. Investigators should address the initiation and assessment of clinical trials to determine whether they establish a standard of care and use an appropriate informed consent process to recruit and enroll subjects, consider whether selection criteria should include the abortion preferences of the pregnant woman, and consider whether physicians have an obligation to offer referral to such investigation. This approach is comprehensive because it takes account of the physician's obligations to the fetal patient, the pregnant woman, and future fetal and pregnant patients.

An ethical justification and policy for making commitments during computerized residency application processes: The US matching program as a laboratory for needed reform.

The US National Residency Matching Program (NRMP) is a computerized, national system for matching residency applicants to programs. Similar systems exist in Canada, Australia, and New Zealand, and the need for such a program will probably make itself felt in the European Union soon. NRMP is an important laboratory for the ethical challenges that computerized matching programs create, especially its current prohibition of making commitments by both applicants and residency programs.

The ethics of psychiatric education.

Evidence-based medicine and the professional virtues of integrity, compassion, self-effacement, and self-sacrifice constitute the cornerstones of an ethics of psychiatric education. As informed by the pioneering work of John Gregory, psychiatric educators must promote evidence-based and ethically justified behaviors in learners and practicing physicians through example and by formal teaching. These processes together will enable patients to trust the competence of psychiatrists and that psychiatrists will serve the interests of patients first.

Reconceptualizing the experience of surrogate decision making: reports vs genuine decisions.

Background: We propose a reconceptualization of surrogate decision making when patients lack an advance directive stating their preferences about life-sustaining treatment. This reconceptualization replaces the current 2-standard model of substituted judgment (based on the patient's prior preferences and values) and best interests (an assessment of how best to protect and promote the patient's health-related and other interests).

Methods: We undertook a conceptual analysis based on the ethics of informed consent, a qualitative study of how surrogates of seriously ill patients experience the surrogate's role, and descriptions of decision making.

To transfer or not to transfer, that is the question.

An elderly patient who underwent a complex emergency abdominal aneurysmectomy two weeks ago is in coma, ventilator dependent, and in severe multisystem organ failure with a deteriorating prognostic index score. The family has become increasingly hostile towards Dr S. Cold, the consultants, the ICU nurses, and the janitorial staff.