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Biomedical subjects

H M Sass

Publications and source records attributed to H M Sass.

At least 19 recordsLinked to original sources
PubMed1998

End-of-life decisions and advance directives in palliative care: a cross-cultural survey of patients and health-care professionals.

In order to explore possible differences in the scope of end-of-life decisions and attitudes toward advance directives (AD) in palliative care, we conducted a survey of 159 patients in palliative care institutions and 93 health-care professionals experienced in palliative care in the United States, Germany, and Japan. Giving an AD in this clinical setting was considered important by patients and professionals. The prevalence of a formal written AD was 79% in the United States, 18% in Germany, and 9% in Japan. In Japan, there was a high prevalence of entrusting all decisions to the family (known as omakase). More than 80% of the patients had negative feelings toward their future decisions in the United States and Germany, in contrast to only 45% in Japan. Although favored by the professionals, there were no specific instruments for obtaining ADs. In Germany and Japan, some patients had given an informal AD. As a pilot content validity step, survey results were used to derive a checklist for content and procedural aspects in end-of-life decision-making. This checklist may provide the basis for developing an instrument to guide physicians, especially non-palliative care specialists, in communication with their patients and their families in this difficult clinical situation.

Advance Directives↗
PubMed1998

Ethics of the allocation of highly advanced medical technologies.

The disproportionate distribution of financial, educational, social, and medical resources between some rich countries of the northern hemisphere and less fortunate societies creates a moral challenge of global dimension. The development of new forms of highly advanced medical technologies, including neoorgans and xenografts, as well as the promotion of health literacy and predictive and preventive medical services might reduce some problems in allocational justice. Most governments and the World Health Organization (WHO) reject financial and other rewards for living organ donors thus indirectly contributing to the development of black markets. A societal gratuity model supporting and safeguarding a highly regulated market between providers and recipients of organs might provide for better protection of those who provide organs not solely based on altruistic reasons. The moral assessment of global issues in allocation and justice in the distribution of medical technologies must be increased and will have to be based on the principles of self determination and responsibility, solidarity and subsidiarity, and respect for individual values and cultural traditions.

Advisory Committees↗
PubMed1998

Genotyping in clinical trials: towards a principle of informed request.

This paper reviews the usefulness of bioethical instruments such as the informed consent principle to handle ethical and political challenges of clinical trials in genotyping and DNA-banking and discusses an informed request model as well as other contractual relations between research institutions, patients, and their families.

Bioethics↗
PubMed1997

Moral aspects of risk and innovation.

In all areas of technological innovation and application, there are nontechnical (moral, cultural, religious, political, and regulatory) risk factors and uncertainties that have to be taken into account if research design and introduction of new devices and applications are to be successful. Products and methods will be beneficial to the patient if they meet personal and cultural expectations. Value assessment of individual patients and of cultural preferences and obstacles therefore has to be included in complex technology assessment. Successful recognition and management of moral and cultural risk factors may require changes in governmental regulation and research design and the development of risk recognition competence within professional organizations.

Beneficence↗
PubMed1997

Organization and patients' perception of palliative care: a crosscultural comparison.

The hospice model of care for patients with advanced diseases exists in almost all industrialized countries. To date, there have been no international or crosscultural comparisons of the organization and patient outcomes associated with hospice services in different parts of the world. This survey evaluated 159 patients in the USA, Germany and Japan. There were differences between countries in the time of first contact, who recommended palliative care first, the underlying diagnoses, the location of patients, and how consent for hospice care was obtained. Across all countries, there were similar levels of comfort and satisfaction with care. We conclude that the hospice philosophy addresses the basic needs of dying patients which are independent of cultural background, but may be adapted to very different cultures.

Aged↗
PubMed1997

[Acceptance and validation of advanced directives--ethical and clinical considerations].

Crucial decisions of end-of-life treatment quite often are handed over to machines and other technical capabilities of prolonging life at any cost. Various forms of advance directives have been developed, but not widely accepted by the lay public and rarely recognized by physicians and the health care establishment. We discuss the benefits and risks of different forms of advance directives and present, based on own experience and on evaluating the clinical-ethical and clinical-legal debates, a model combining information on value-and-wish status, the designation of a surrogate decision maker, and a limited number of recommendations or directives for crucial end-of-life decisions. We call for further research on physician's and patient's attitudes towards end-of-life decisions and the development and validation of advance directives, as we feel that it will be the culture of physician-patient interaction rather than legal measures that will change ethical and cultural attitudes and medical procedures.

Advance Directives↗
PubMed1997

[Values anamnesis: a narrative approach to determining and interpreting advance directives].

Quite a number of conceptual, clinical, ethical and legal arguments have been made to agree in favour of advance directives for medical treatment and care. But not many patients execute advance directives and physicians and nurses are quite reluctant to accept advance medical directives as authoritative guidance for clinical decision making in cases of dementia, terminal illness or in the case of the dying.

Advance Directives↗
PubMed1995

From wooden limbs to biomaterial organs: the ethics of organ replacement and artificial organs.

This paper discussed issues of ethical assessment and moral concern associated with organ replacement and physical enhancement: research, allocation, organ donation, artificial organs, xenografts, biomaterials, and neuromaterials. While emphasizing the medical and moral benefits over associated risks, it calls for a better integration of moral assessment into technology assessment and for the establishment of a cross-cultural and interdisciplinary International Ethics Committee for Organ Replacement Therapy.

Artificial Limbs↗
PubMed1993

[Ethics in epidemiology].

Progress in epidemiology was instrumental for recognising health risk factors and emphasising health protection and health risk prevention; it may contribute to a Copernican turn in setting new priorities in health care politics and health care ethics, in redefining health, disease, and individual health literacy and responsibility. This paper reviews recent national and international activities to formulate a Code of Ethics for Epidemiologists and evaluates central bioethical principals for epidemiologists.

Epidemiology↗
PubMed1992

Right not to know or duty to know? Prenatal screening for polycystic renal disease.

New dimensions in different ethical scenarios following genetic information require new medical-ethical Action Guides for physician-patient interaction. This paper discusses the ambiguity in moral choice between a "right not to know" and "a duty to know", regarding parental decision-making pro or contra selective abortion following prenatal screening for autosomal dominant polycystic kidney disease (Potter III) and related public policy issues.

Abortion, Legal↗
PubMed1992

Criteria for death: self-determination and public policy.

'Whole brain death' criteria have found support in Western cultures in regard to post-mortem organ donation and the termination of care for patients meeting these strict criteria. But they are of minimal use in Asian cultures and in the ethics of caring for the persistent vegetative patient. This paper introduces a formula for a global Uniform Determination of Death statute, based on the 'entire brain including brain stem' criteria as a default position, but allowing competent adults by means of advance directives to choose other criteria for determining death during the process of dying.

Bioethics↗