Conflicts of interest: are informed consent an appropriate mode and disclosure an appropriate remedy?

Conflict of interest (COI) in dentistry is typically thought to arise when a dentist's exercise of professional judgment for the sake of a patient's interest is compromised by a secondary interest such as increase of reputation or financial gain. Disclosure of conflict of interest is often recommended as a remedy to prevent the erosion of the fiduciary relationship and to permit patients to take steps to protect their own interests. Borrowing the concept of a reasonable patient from discussions of disclosure standards for informed consent, this paper offers a patient-centered definition of COI: a COI exists when the presence of a dentist's secondary interest undermines the reasonableness of a reasonable patient's reliance on his or her dentist's professional judgment.

Patient safety, error reduction, and ethical practice.

Currently, patient safety and adverse outcomes are receiving an increasing emphasis within both the healthcare community and society. Redesigning systems and instituting safe practices within the healthcare environment are being seen as essential to decrease the likelihood that patients are placed at risk of harm. Adopting a change in practice may not be the answer because there may be unintended consequences from the new procedure.

When patients and families disagree.

Advance care planning is meant to safeguard the patient's autonomy when that individual is unable to make his or her own healthcare decisions. Yet, families do not always agree with the specific wishes of their family member when there is a need to make critical decisions, such as continuing treatment because of some new research protocol or providing comfort through palliative care. When there are patient-family disagreements, the decision-making process is even more complicated if the patient is fully able to participate because competent patients have the right to make their own healthcare decisions.

HIPAA--clinical and ethical considerations for nurses.

Congress enacted the Health Insurance Portability and Accountability Act (HIPAA) to protect patients' basic rights to privacy and their control over the disclosure of their personal health information. Advances in and the more widespread use of communication technology were increasing the public's concerns over the ease with which their health information could be transmitted, how protected that information was during such transmissions, and their lack of approval for the use of that information by known and unknown third parties. This article, the first of two papers focusing on HIPAA, discusses HIPAA from the clinical perspective and focuses primarily on the HIPAA Privacy Rule.

When race matters.

Several widely held assumptions shape end-of-life discussion in the United States. They are embedded in mainstream bioethics and biomedical discourse, debate, and discussion, as well as in the popular media. We have come to regard them as the conventional wisdom.

Brief communication: the relationship between having a living will and dying in place.

Background: Living wills, a type of advance directive, are promoted as a way for patients to document preferences for life-sustaining treatments should they become incompetent. Previous research, however, has found that these documents do not guide decision making in the hospital.

Objective: To test the hypothesis that people with living wills are less likely to die in a hospital than in their residence before death.

The effects of organization on medical utilization: an analysis of service line organization.

Objectives: To determine whether clinical service lines in primary care and mental health reduces inpatient and urgent care utilization.

Methods: All VHA medical centers were surveyed to determine whether service lines had been established in primary care or mental health care prior to the beginning of fiscal year 1997 (FY97). Facility-level data on medical utilization from Veterans Health Affairs (VHA) administrative databases were used for descriptive and multivariate regression analyses of utilization and of changes in measures between FY97 and FY98.

Caring doesn't end.

Despite the advances in healthcare technology and the new treatment regimens, all patients are not eligible for these treatments. Although some providers might indicate that there is nothing more that they can do, other healthcare providers do not give up on their patients and families. They continue to provide care, regardless of whether treatment options have been exhausted, and help these patients to have a "good death.

Technology. Possibilities and pitfalls.

An amazing growing area in healthcare is the increase in the development of technology that is designed to augment human functioning and decrease an individual's dependence on others to provide personal care. Yet, what does it mean to extend a person's life through technology? Within the context of a hypothetical case, this article considers ethical questions raised by new and futuristic technologies designed to augment human functioning. These ethical issues are grounded within the context of the possibilities and the pitfalls of technology.

Should we promote influenza vaccination of health care workers in nursing homes? Some ethical arguments in favour of immunization.

Although studies show the relation between influenza immunization of health care workers and the benefits for residents in nursing homes, compliance to vaccination is still low. In this article we explore and discuss two specific moral reasons for nursing home professionals to accept vaccination. These special reasons derive from two sources: the responsibilities they have as health professionals, and the responsibilities they have as a member of the collective.

When all do not have the same. Health disparities.

Eradicating health disparities and increasing health-related quality of life are the overall goals of Healthy People 2010. To achieve these goals requires that healthcare providers have an understanding of respect for individuals, trust, and implications of distributing resources equitably within society. The purposes of this article are to discuss health disparities and to briefly describe how ethics helps healthcare providers address health disparities.

In the high court of South Africa, case no. 4138/98: the global politics of access to low-cost AIDS drugs in poor countries.

In 1998, 39 pharmaceutical manufacturers sued the government of South Africa to prevent the implementation of a law designed to facilitate access to AIDS drugs at low cost. The companies accused South Africa, the country with the largest population of individuals living with HIV/AIDS in the world, of circumventing patent protections guaranteed by the intellectual property rules that were included in the latest round of world trade agreements. The pharmaceutical companies dropped their lawsuit in the spring of 2001 after an avalanche of negative publicity.

From Lydia Pinkham to Bob Dole: what the changing face of direct-to-consumer drug advertising reveals about the professionalism of medicine.

From its founding in 1847, the AMA divided drugs into "ethical" and "unethical" preparations. Those that were ethical had a known composition and were advertised only to the profession. Other, patent medicines (technically proprietary drugs, whose trademarks were protected by copyright), were sold directly to the public.

When there are limits on health care resources.

Controlling health care costs has been a goal within the health care system for nearly 40 years. Yet, what is occurring is that health care costs are actually increasing, and the quality of care is decreasing. Patients and health professionals are complaining that accessibility to services is limited.