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Biomedical subjects

D C Thomasma

Publications and source records attributed to D C Thomasma.

At least 91 records · Page 5Linked to original sources
PubMed1984

Ethical issues in the treatment of patients with a remitting vegetative state.

A case of remitting vegetative state is presented illustrating the need to draw a distinction between persistent and remitting vegetative states in brain-damaged patients. Standard ethical considerations regarding dying patients cannot be universally applied to remitting vegetative states, which are best handled in a context of an ethics of discretion, rather than an ethics of rules. Ethical obligations towards such persons are presented. When the patient cannot assent to withdrawal of treatment, it is suggested that decisions be made on the side of preserving life until the course becomes evidently downhill.

Aged↗
PubMed1984

Freedom, dependency, and the care of the very old.

Difficulties exist in making treatment decisions for the very old and dependent patient. In the years to come, these difficulties will increase. It is argued that such persons should not be abandoned to their "rights" as autonomous persons; yet quality of life judgments should also be avoided except in limited circumstances. Since aging is a process of becoming more dependent, the author proposes a dependency rule, by which greater responsibility for treatment decisions falls on care-givers as a person's dependency increases. In place of quality of life judgments he suggests a medical indications policy, if the latter includes restoration of some affective function. Five kinds of freedom are proposed, of which only some are lost in chronic illness and old age. Finally, it is suggested that life itself involves greater interdependence than the autonomy criterion itself can allow. The author focuses on the problem of dependency in the aged and the role an increase in this dependency plays, with corresponding loss of personal autonomy, in quality of life judgments. These, in turn, form the basis for treatment decisions.

Activities of Daily Living↗
PubMed1983

Beyond medical paternalism and patient autonomy: a model of physician conscience for the physician-patient relationship.

Medical paternalism lies at the heart of traditional medicine. In an effort to counteract the effects of this paternalism, medical ethicists and physicians have proposed a model of patient autonomy for the physician-patient relationship. However, neither paternalism or autonomy are adequate characterizations of the physician-patient relationship. Paternalism does not respect the rights of adults to self-determination, and autonomy does not respect the principle of beneficence that leads physicians to argue that acting on behalf of others is essential to their craft. A model of physician conscience is proposed that summarizes the best features of both models--paternalism and autonomy.

Beneficence↗
PubMed1982

Ethical complications of clinical therapeutic research on children.

Usual discussion by ethicists and physicians of the ethical implications of research on children with catastrophic disease, and the guidelines established by the Federal Government for this research, rest on applying general moral principles to problems. Whatever the merits of this approach for establishing policy, it does not adequately reflect the life situation of patients and the complexity of a single regimen which is simultaneously both therapeutic and research oriented. Also, the issues become more complex when there is disagreement among the parents about a course of treatment. It is our contention that such cases are properly resolved by considering the degree of paternalism to be exercised by the clinician-researcher.

Adolescent↗