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Biomedical subjects

J F Drane

Publications and source records attributed to J F Drane.

At least 19 recordsLinked to original sources
PubMed1993

The concept of futility. Patients do not have a right to demand medically useless treatment. Counterpoint.

Traditionally, applying the principle that physicians do not provide treatments when the interventions at their disposal do not produce medical benefits has been relatively straight-forward. However, with the growing importance of patient autonomy and informed consent in treatment decisions, ethicists must now balance this principle with the principle of patient self-determination. A patient's right to choose or refuse treatment is limited by the physician's right (and duty) to practice medicine responsibly. Bizarre or destructive choices made by a patient are not sacrosanct simply because the patient made them. In some cases, physicians may choose not to act on patient decisions that appear to be unreasonably destructive. Physicians also have a right to refuse to provide futile treatments (i.e., interventions that might be physiologically effective in some sense but cannot benefit a patient). Patients themselves have a right to provide input into what would constitute a "benefit" for them, but physicians should be able to decide when a particular treatment is futile based on their knowledge of the treatment's effects and its likely impact on a patient's quality of life. Ethical rules covering futility can be developed based on socially sanctioned standards of rationality and traditional physician-based values. Clarifying the concept of futility and establishing defensible ethical policies covering futility are important steps toward eliminating unhelpful, medically inappropriate practices.

Beneficence↗
PubMed1993

Market economics and biomedical ethics.

Though biomedical ethics has only recently been recognized as a major new medical field, the connection between the practice of medical professionals and the ethics of medical practice dates back to the beginning of Western medicine. More recently, ethics has become more and more involved with economics.

Attitude of Health Personnel↗
PubMed1992

Anencephaly and the interruption of pregnancy: policy proposals for HECs.

This article is directed to hospital communities where absolute proscriptions exist against abortion. The assumption is that many will be Catholic institutions and therefore Catholic moral teachings are examined carefully. By addressing anti-abortion arguments in the context of anencephaly, I hope to show that within even the most conservative moral traditions, humane exceptions to absolute proscriptions against abortion can be justified. More specifically, the article is directed to HECs which either have unstated or ambiguous policies on abortion. It will attempt to show what a reasonable policy could look like and how it could be defended. For committee members not involved in policy questions about abortion, it may stimulate some ethical discussion.

Abortion, Induced↗
PubMed1992

Medical ethics and maternal-fetal conflicts.

As ethical issues are raised by more and more aspects of medical practice, medical ethics becomes an ever more complex and confusing enterprise, presenting yet another physician dilemma. This article offers guidelines for individual physicians and hospital ethics committees in dealing with medical ethics and maternal-fetal conflicts.

Child Advocacy↗
PubMed1991

Medical ethics in the 1990s. Emphasis on death-and-dying issues will continue but social concerns will command increased attention.

During the 1990s medical ethics will undergo changes. Individual clinical issues, especially those related to death and dying, will continue to create conflict and preoccupy hospital staffs. But professional ethicists will focus on social concerns more frequently than they have in the past. Following are some of the most crucial ethical issues and directions they are likely to take in this decade: Clinical practice and the law will move toward less demanding standards of proof regarding the withdrawal of treatment from patients who are no longer competent. Public policy will set more lenient standards for judging whether a person would refuse artificial nutrition and hydration if he or she were able. Unless sensible people strengthen the distinction between active and passive euthanasia, more physicians and legislatures will move toward physician-assisted suicide. Those proposing a higher-brain definition of death, as opposed to whole-brain definitions, will gain ground with the general public, but not with legislators. New transplantation technologies will increase medical options but create more problems with paying for the procedures. As techniques are perfected, ethical questions will focus more on financing than on the source of transplantable material. AIDS treatment priorities will clash with other medical demands (e.g., treatment for breast cancer), and concerns about protecting both providers and patients from contracting AIDS will move policy toward routine testing. Progress in public argument will be made on the abortion issue. Members of ethics committees will have to be trained to address financing issues. Some medical schools and residency programs will add courses on the concept of character and on character development to their ethics programs.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Legal↗
PubMed1991

Karl A. Menninger: psychiatrist and moralist.

Karl Augustus Menninger, whom the American Psychiatric Association declared "America's greatest living psychiatrist," died July 18, 1990, in Topeka, KS. He had lived there his entire life. In 1993 he would have been 100 years old. The name "Menninger" has become synonymous with psychiatry, principally through the work of this one man. In 1925, with his father and his brother William, he established the Menninger Foundation, a world-famous center for research, education, and treatment of mental illness. A leader in psychiatry for more than 70 years, Menninger wrote more than a dozen books and hundreds of articles. He gave thousands of lectures and directly helped thousands of psychiatric patients in addition to the hundreds of thousands of people he touched through his writings.

Ethics, Medical↗
PubMed1990

Noblesse oblige.

Explore the source record for details and available documents.

Aged↗
PubMed1990

National survey of ethical issues presented to drug information centers.

Whether and how drug information centers respond to calls from the public that involve ethical issues was studied. A survey describing six ethical dilemmas typical of those presented by calls from the public was mailed to pharmacists in 154 drug information centers to see how the questions would be handled. Centers that had written policies governing responses to questions with ethical implications were asked to submit those policies. One hundred twenty-six centers (82%) responded to the survey; of these, 81 (64.3%) answered questions from the public. There were no significant differences in characteristics between centers that did and did not respond to public calls. The case analyses, completed only by pharmacists in centers that responded to public calls, covered such issues as invasion of privacy, social responsibility, personal liability, and interference with the patient-physician relationship. Respondents exercised a wide degree of discretion in determining if they would answer a question; for example, while only 4% would not answer a question concerning the efficacy of a weight-loss diet patch, 77% reported they would not respond to a caller asking for information on drugs that could interfere with the results of a polygraph test. Although respondents often cited institutional policy as the reason for failing to respond to a question, none submitted a copy of such a policy. The pharmacists' responses indicated a high degree of moral and social sensitivity; nonetheless, written policies should be developed to assist drug information center staff members in handling questions that have ethical implications.

Adrenergic beta-Antagonists↗
PubMed1990

Methodologies for clinical ethics.

Truly professional medical ethics requires a methodology that generates both moral discernment and consistently right judgments. In this article the author briefly reviews difficulties involved in ethical decision-making, the historical development of casuistry, and four ethical methodologies employed in clinical medicine today. These latter, which are outlined and compared, are as follows: the methodology developed by David Thomasma in the 1960s and 1970s; one created by Jonsen, Siegler, and Winslade; another developed by the author; and the Bochum Protocol authored by Hans-Martin Sass et al. of the Bochum Center for Medical Ethics in the Federal Republic of Germany.

Casuistry↗
PubMed1989

Playing God in the NICU. Ethical guidelines focus on what seems best for the handicapped infant--Saint Vincent Health Center, Erie, PA.

Physicians, nurses, and administrators of Saint Vincent Health Center, Erie, PA, embarked on a project to refine ethical standards regarding the treatment of severely handicapped infants to meet current government regulations and to express the hospital's Catholic ethical ideals. The guidelines they developed do not lead to precise conclusions; rather, they direct the search for right decisions. Complicating the development of guidelines are psychological considerations, medical ambiguities, and economics. One reaction to the attempt to establish guidelines for decision making for very ill and handicapped infants is predictable: What right does anyone have to decide who will live and who will die? Who can play God? But healthcare providers must all play God because they have no alternative. If playing God means making life-and-death decisions, then being stewards of human life involves just such a responsibility. Medical professionals working with severely handicapped infants know they cannot avoid this responsibility. Caring human beings simply have to decide for helpless others. The guidelines developed by the Pediatrics Ethics Committee at Saint Vincent Health Center focus on what seems to be best for the dependent and helpless infant, who rightly has a claim on our support, care, love, and concern.

Congenital Abnormalities↗