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Biomedical subjects

J D Lantos

Publications and source records attributed to J D Lantos.

At least 37 records · Page 2Linked to original sources
PubMed1993

The case. What should Leah be told?

Fearing that his 18-year-old daughter will value her fertility more than her life, an Orthodox Jewish father implores physicians not to seek her informed consent for surgery for vaginal cancer.

Adolescent↗
PubMed1992

Ethical aspects of pediatric home care.

This essay is a discussion of ethical issues that arise in the provision of home health care to technology-dependent children. Different ethical norms, especially with regard to the degree of professional responsibility for outcomes, traditionally have applied to home care and hospital care. In particular, parents generally are expected to do their best, but are not expected to have the same specialized knowledge of risks and benefits with regard to particular interventions as health professionals. When home health care involves the use of advanced medical technology, it strains traditional conceptions of parental responsibilities to care for the health of their children at home. It can also strain traditional concepts of professional responsibilities to care for critically ill children in hospitals. We discuss some of the tensions that arise as medical, psychological, and economic forces lead to the increasing use of high technology in the care of children outside of traditional health care institutions.

Child↗
PubMed1991

Pediatrician's practice choices: differences between part-time and full-time practice.

A national survey was used to study the differences in career and family patterns of pediatricians who work part-time (PT) vs those who work full-time (FT). A questionnaire mailed to 375 members of the American Academy of Pediatrics asked about age, marital status, number of children, type of practice, hours worked in particular duties, and attitudes about their choices. Sixty-five percent (n = 216) of the questionnaires were completed. The mean age of both the PT and FT women was 40 years, and FT men averaged 46 years. Thirty-seven percent of women had worked PT at some point in their careers; 21% were currently working PT. Only 70% of the FT women were married compared with 97% and 95% of PT women and FT men. The FT women had significantly fewer children (mean 1.27, compared with 2.34 for PT women and 2.39 for FT men). Part-time women in academic medicine tended to do little research or administrative work, but they had more teaching responsibilities. Almost all the PT women were happy with their decisions and careers despite the feeling among many that they had made career compromises. Many of the FT pediatricians wanted to work less. It is concluded that many women, particularly those with children, choose PT work in order to combine career and family duties. These choices may lead to different career paths for women pediatricians. By recognizing these different career paths, it may be possible for academic institutions to benefit from the unique contributions that PT women pediatricians can make.

Adult↗
PubMed1990

The ethical assessment of innovative therapies: liver transplantation using living donors.

Liver transplantation is the treatment of choice for many forms of liver disease. Unfortunately, the scarcity of cadaveric donor livers limits the availability of this technique. To improve the availability of liver transplantation, surgeons have developed the capability of removing a portion of liver from a live donor and transplanting it into a recipient. A few liver transplants using living donors have been performed worldwide. Our purpose was to analyze the ethics of liver transplants using living donors and to propose guidelines for the procedure before it was introduced in the United States. We used a process of "research ethics consultation" that involves a collaboration between clinical investigators and clinical ethicists. We concluded that it was ethically appropriate to perform liver transplantation using living donors in a small series of patients on a trial basis, and we published our ethical guidelines in a medical journal before the procedure was introduced. We recommend this prospective, public approach for the introduction of other innovative therapies in medicine and surgery.

Directed Tissue Donation↗
PubMed1989

Autonomy in adolescent medicine. A framework for decisions about life-sustaining treatment.

A broad consensus has been reached in the last decade about the appropriateness of decisions to withhold life-sustaining treatment from competent adult patients. The situation in adolescent medicine is not so straightforward. Legal ambiguity in determining competence and clinical difficulty in assessing decision-making capacity make such decisions in adolescent medicine problematic. A framework for making decisions about withholding or withdrawing life-sustaining therapy from adolescent patients is proposed, and cases are given to illustrate the way the framework may be applied.

Adolescent↗
PubMed1989

The illusion of futility in clinical practice.

The claim that a treatment is futile is often used to justify a shift in the physician's ethical obligations to patients. In clinical situations in which non-futile treatments are available, the physician has an obligation to discuss therapeutic alternatives with the patient. By contrast, a physician is under no obligation to offer, or even to discuss, futile therapies. This shift is supported by moral reasoning in ancient and modern medical ethics, by public policy, and by case law. Given this shift in ethical obligations, one might expect that physicians would have unambiguous criteria for determining when a therapy is futile. This is not the case. Rather than being a discrete and definable entity, futile therapy is merely the end of the spectrum of therapies with very low efficacy. Ambiguity in determining futility, arising from linguistic errors, from statistical misinterpretations, and from disagreements about the goals of therapy, undermines the force of futility claims. Decisions to withhold therapy that is deemed futile, like all treatment choices, must follow both clinical judgments about the chance of success of a therapy and an explicit consideration of the patient's goals for therapy. Futility claims rarely should be used to justify a radical shift in ethical obligations.

Attitude of Health Personnel↗
PubMed1988

Survival after cardiopulmonary resuscitation in babies of very low birth weight. Is CPR futile therapy?

We conducted a retrospective study of outcome after cardiopulmonary resuscitation (CPR) in babies of very low birth weight. Of 158 such babies (birth weight, less than 1500 g) admitted to a neonatal intensive care unit in 1985, 49 (31 percent) underwent CPR. Low birth weight, low Apgar scores, birth asphyxia, pulmonary interstitial emphysema, hyaline membrane disease, and severe intraventricular hemorrhage were associated with the need for CPR. None of the 38 babies who received CPR in the first three days of life survived. Four of the 11 babies who received CPR after the first 72 hours survived. Three of the four survivors had residual neurologic deficits. Survival rates after CPR in infants of very low birth weight are lower than those in older children or adults. CPR may therefore be considered a nonvalidated therapy in this population. If the results of our study are confirmed, CPR should not be instituted automatically in very-low-birth-weight babies as though it were a validated treatment. Instead, it should be administered upon parents' advance informed consent to experimental treatment.

Apgar Score↗
PubMed1988

The total artificial heart. An ethics perspective on current clinical research and deployment.

The development of the total artificial heart (TAH) as a support before cardiac transplantation and as a possible permanent prosthesis has generated intense debate. The social commitment to TAH research entails immense health care costs because of the cost of the implant itself and also because of the large number of patients whose interests impel the research. The deployment of the pre-transplant TAH during the current shortage of donor hearts means that the TAH creates its own incentive as a way to compete in an expanded pool of donor heart candidates. Policies to address the orderly deployment and costs of the pretransplant TAH are needed. Research design and current pre-transplant clinical applications require careful consideration of planning for the termination of TAH support for severely injured but not brain dead patients.

Costs and Cost Analysis↗