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J F Drane

Publications and source records attributed to J F Drane.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1988

"Ethical workup" guides clinical decision making.

Shared decision making, along with an explosion in costs and the alternatives associated with the technological revolution in medicine, has moved medical ethics from the status of a professional etiquette to that of a rigorous new discipline. A model for an "ethical workup," which medical professionals can use in healthcare setting, has four phases: expository, rational, volitional, and public. The expository phase includes medical factors, which are the most important for determining the right or wrong thing to do for a patient; ethical factors, which involve the interests, intuitions, and feelings of all those involved in a case; and socioeconomic factors, in which costs that create burdens on others become important, and in some cases decisive, considerations. The rational phase includes medical ethics categories, which determine the type of case one is facing; principles and moral guidelines, which justify decisions; and legal decisions and professional codes, which synthesize accepted wisdom about appropriate ethical behavior. The volitional phase includes ordering goods and values, which involves establishing priorities and weighing certain factors; ordering the principles, which reflect personal or institutional character and is influenced by religious and philosophical beliefs; and decision making, in which professionals consider a decision's impact on their profession, their facility, and themselves. The public phase includes making assumptions explicit, which means professionals should try to recognize underlying beliefs, admit their influence on preferred positions, and be sensitive to other perspectives and preferences; correlating initial feelings about right and wrong with the reasons supporting a decision; and organizing reasons for public communication.

Bioethical Issues↗
PubMed1987

Medical decision making for the incompetent patient.

In America competent adult patients have a right to refuse unwanted medical treatments. For incompetent patients who have made no advance directive, the family ordinarily makes decisions about medical treatments. But in many healthcare facilities, problems arise in choosing a surrogate to make decisions for an incompetent patient and in working with that surrogate. Concrete, step-by-step procedures for resolving conflict are needed. Every effort should be made to have competent patients fill out advance directives or indicate their treatment preferences in the event of loss of competence. Family members may not override decisions made by competent patients, but anyone closely involved with the patients' care may question their competence. The physician generally assesses the patients' competence, but sometimes the courts are involved. The physician may be the appropriate person to choose a surrogate for a patient with limited competence or to make decisions for a totally incompetent patient. The surrogate may be a relative, close friend, physician who knows the patient well, or someone provided by the hospital or government. Treatment decisions are made within the surrogate-patient-physician triad. When different value judgments about the proper treatment conflict, the surrogate may have to mediate to restore physician-patient communication, or institutional proceedings through the ethics committee may be needed to resolve disputes quickly, amicably, and at low cost. As a last resort, the case may be referred to the courts.

Conflict, Psychological↗
PubMed1986

A methodology for making ethical health care decisions.

Medical professionals have no alternative to using an ethical methodology in their practice if they are to retain public confidence and resist public pressure for more legal oversight of medical practice. The method presented here for making ethical decisions points toward objectivity, is rigorous, and aims at publicly defensible choices. It involves four major stages: Expository, descriptive phase. The decision maker investigates medical and human factors and then identifies the involved parties' interests and feelings. Rational, analytic phase. The professional identifies medical ethics categories, conceptual distinctions (e.g., direct and indirect killing), principles and moral guidelines, and legal decisions or professional codes, as they apply to the situation. Volitional, decisional phase. The person then turns to making a defensible decision. This involves ordering goods and values, choosing the governing principles, and finally making a decision that considers the effect on all concerned. Public, reflective phase. The professional defends choices by making assumptions explicit, correlating reasons and feelings, and organizing reasons for public communication.

Bioethical Issues↗
PubMed1986

A challenge to examine the meaning of living and dying.

The case of Paul Brophy, decided by a four-to-three vote of the Supreme Judicial Court of Massachusetts, focused on the patient's right to terminate artificial nutrition and hydration. According to the majority opinion, artificial feeding is an "intrusive" procedure that one should be able to refuse without being accused of committing suicide. The court based its reasoning on the right to privacy and, in relation to that right, the state's interests in preserving life, protecting innocent third parties, preventing suicide, and maintaining the medical profession's ethical integrity. The majority could have been more persuasive, however, if it had considered Catholic moral tradition in developing its argument, especially the importance of judging a treatment's outcome and burden in relation to the individual patient's life. The Brophy opinion probably will leave many people dissatisfied because it fails to explore the values of the parties involved and the meaning of Catholic teaching. It should serve as a challenge, however, to the Catholic community to more fully articulate for a technologically oriented culture the meaning of living and dying.

Catholicism↗
PubMed1985

Institutional ethics committees: what, how, and why.

Because institutional ethics committees can reduce the risk of tragic mistakes by clinical decision makers and provide interdisciplinary input into decisions, they may be a requirement for all hospitals by the end of this decade. Ethics committees should not in themselves be decision-making entities, however. Their proper functions are to advise physicians, patients, and families; facilitate communication; provide in-house education; assist in policy formulation; mediate between ethical theory and concrete medical judgments as well as between the institution's values and those of the larger community; provide support for those involved in painful decisions; and minimize the institution's vulnerability to litigation. Although ethics committees have been endorsed by federal agencies, a presidential commission, and numerous health care organizations, several obstacles remain. Physicians are afraid that their decisional prerogatives will be wrested from them; a committee could become a rubber-stamp organ for one powerful member, one special-interest group, or one perspective, confidentiality policies would have to be extended to nonhospital committee members; and medical personnel feel threatened by the exposure of errors or bad judgment. Nonetheless, ethics committees are a promising structural adjustment to ethical pressures exerted by new technology and the growing number of health care disciplines.

Ethical Review↗
PubMed1984

Competency to give an informed consent. A model for making clinical assessments.

A patient's decision must be informed and free, and he/she must be competent either to consent to or refuse treatment. Rather than selecting a single standard of competency, a sliding scale is suggested that requires an increasingly more stringent standard as the consequences of the patient's decision embody more risk. The standard of competency to consent to or to refuse treatment depends on the dangerousness of the treatment decision. Three different standards are correlated with the psychiatric abnormalities that are most likely to undermine them. A model with guidelines for use is provided to aid the physician who is called on to make a determination of competency.

Comprehension↗
PubMedDate not supplied

The defective child. Ethical guidelines for painful dilemmas.

The Surgeon General's regulations requiring treatment of defective newborns were criticized for being simplistic and for interfering in medical decision-making. This public policy regulation was at variance with many of the recommendations of the President's Commission for the Study of Ethical Problems in Medicine. Taking the President's Commission's report into consideration, this article proposes tentative guidelines for making difficult clinical decisions, which may form the basis of an institutional or a professional response to dilemmas surrounding the birth of a defective child.

Child Advocacy↗