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Biomedical subjects

J E Frader

Publications and source records attributed to J E Frader.

12 recordsLinked to original sources
PubMed2001

Innovation and research in pediatric surgery.

Progress in pediatric surgery has relied primarily on the diffusion of innovations as reported in case series in the literature. The standards applied to clinical research that predominate in medical specialties have not become common in surgery, despite agreement that comparative trials produce the best evidence. Many pediatric surgical interventions compete with similar or even radically different surgical and medical approaches to the same condition. The resulting confusion about how to proceed raises serious ethical questions for physicians and families facing major decisions about surgery, medical therapy, or comfort care. Pediatric surgeons have a moral obligation to undertake formal research comparing their preferred operations to alternative approaches.

Child↗
PubMed1996

Ethical issues in organ procurement: a review for intensivists.

The current state of organ procurement and the ethical issues raised by the procurement process are reviewed in this article. After an examination of the legislative framework governing organ procurement, the intensivist's role in donation is discussed, including (1) donor identification, (2) asking the family to donate, and (3) obtaining consent. Recent proposals for changing the organ procurement system are analyzed, including increasing family donation or increasing the donor pool.

Death↗
PubMed1992

Political and interpersonal aspects of ethics consultation.

Previous papers on ethics consultation in medicine have taken a positivistic approach and lack critical scrutiny of the psychosocial, political, and moral contexts in which consultations occur. This paper discusses some of the contextual factors that require more careful research. We need to know more about what prompts and inhibits consultation, especially what factors effectively prevent house officers and nonphysicians from requesting consultation despite perceived moral conflict in cases. The attitudes and institutional power of attending medical staff seem important, especially where innovative interventions raise ethical questions. Ethics consultants also need to address the thorny problems of the origin(s) of the consultant's authority, whistleblowing, conflicts of interest that affect the consultant, persistently poor communications in hospitals, systemic inequity in the availability or quality of services for some, and the standing of the consultant's recommendations, including their appearance in the patient's medical record.

Bioethical Issues↗
PubMed1990

AIDS and its impact on medical work: the culture and politics of the shop floor.

AIDS, together with other institutional factors, is changing the "shop-floor" culture of house officers and students in urban, academic medical centers. These medical workers complained of powerlessness and exploitation prior to the epidemic, but they felt pride in scoring clinical coups and chagrin in their clinical defeats, characteristic of an adolescent sense of invulnerability. The HIV epidemic, dovetailing with the intensely competitive economic environment in medical settings, subjects house officers to increasingly demanding schedules, heightens their sense of powerlessness, and limits their sense of professional achievement. Fear of contagion, moreover, is erasing their perception of invulnerability.

Academic Medical Centers↗
PubMed1985

Selecting neonatal ethics.

Nontreatment of handicapped newborns has disturbed American society, prompting heated debate and new attempts by government at regulation. Robert Weir's new book reviews the elements of this controversy as argued by concerned doctors, lawyers and ethicists. Unfortunately, we do not know the magnitude or scope of the problem. We know little about how often or under what circumstances physicians practice nontreatment. In discussing the issues, Weir and others have paid inadequate attention to medical uncertainty. The inability to accurately predict outcome makes clinical judgment harder than most philosophers and others acknowledge. Many legal arguments are outdated. The concept of personhood Weir and ethicists invoke confounds decision making. Complex or uncertain medicomoral dilemmas will not be resolved more easily by ethics committees. This procedural solution to a substantive quandry creates new problems. More attention must be paid to patients' current and future suffering when deciding whether to treat severely handicapped infants.

Persons with Disabilities↗
PubMed1979

Difficulties in providing intensive care.

The results of a pilot project investigating the feelings, attitudes, and behavior of physicians working in a pediatric intensive care unit are presented. With recent technologic advances in out capacity to help patients suffering from catastrophic illness, various segments of American society have become concerned about the unrestricted use of medical science. Questions have arisen about the economic costs, long-term medical outcome, emotional costs to patients and families, legal problems, and ethical implications of "heroic" therapy. By contrast, we have asked relatively few questions about the social processes involved in providing intensive care. We know little about the emotional and functional responses of the physicians in critical care facilities, and their decision making processes remain obscure. This investigation evolved from the conviction that environments comprised of sophisticated medical technology and extensive life support systems pose pressing problems for those working and learning in them.

Attitude of Health Personnel↗